Advance care planning: implementing online education for rural primary care providers

Abstract

Advance care planning (ACP) can assist patients and their families in navigating personal and medical choices at the end-of-life; however, these conversations often transpire too late. Primary care providers (PCPs) frequently develop extended relationships with their patients, especially those with chronic disease, and possess opportunities throughout a patient’s lifespan to assess when ACP conversations could be initiated. Unfortunately, many PCPs lack confidence in leading ACP conversations, although they are willing to facilitate them. Despite the alarming number of people living with chronic disease and documented benefits of ACP, advance directive completion remains low. According to previous research, online ACP education for PCPs can bridge gaps in end-of-life care by increasing overall perceived knowledge, confidence, and understanding of ACP and advance directives. The purpose of the practice improvement project was to improve rural PCPs perceived knowledge and confidence in facilitating ACP discussions and to increase the completion rate of advance directives among adults living with chronic disease(s) seen within the rural primary care setting. The theoretical underpinning for this DNP project was Lewin’s Theory of Behavior Change. Project implementation occurred within a federally qualified health center comprised of eight clinics throughout rural North Dakota. The project’s design methodology was a quantitative, quasi-experimental study using a convenience sample of eight PCPs employed within the federally qualified health center. Participants could access the ACP educational webinar, surveys, and posttest for four weeks. Four participants (50%) participated in the practice improvement project and acquired continuing education credit from the North Dakota Board of Nursing. The surveys aided in assessing participants’ reported ACP knowledge, confidence, perceived benefits of ACP, and prior experiences in initiating advance directives and ACP conversations before and after viewing the webinar. The outcomes of the practice improvement project objectives were evaluated and demonstrated an increase in participants’ perceived knowledge and confidence of ACP, an increase in PCPs' reported knowledge of the Serious Illness Conversation Guide, and an improved understanding of the role of ACP facilitators.