A small, pilot quality improvement (QI) project demonstrated that an advance care planning (ACP) intervention involving a face-to-face discussion between patients with metastatic cancer and an advanced practice provider (APP) promoted both patient understanding of ACP and the willingness of patients to complete advance directive documents. This study was published in the Clinical Journal of Oncology Nursing.
Described by the study authors as “a voluntary and ongoing process of communication among patients, family members and caregivers, and healthcare professionals to understand, review, and plan for future healthcare decisions,” a central aim of ACP is to facilitate patient communication regarding their personal values, goals, and preferences regarding future medical care so as to allow for completion of an advance directive document that includes selection of a medical power of attorney and creation of a living will statement that summarizes a person’s wishes regarding end-of-life medical care. Notably, since 2016 ACP is covered under Medicare.
This QI survey study included 36 patients (19 undergoing treatment in the outpatient setting and 17 in the inpatient setting) with metastatic cancer who agreed to participate in ACP conducted by an advanced practice provider certified in ACP. Study data related to documentation of the ACP discussion, completion of an advance directive document, change in code status, and completion of an out-of-hospital do-not-resuscitate (OOHDNR) form were collected retrospectively through chart review by an independent senior social worker.
Some of the key study findings were that 82% and 89% of patients in inpatient settings and outpatient settings, respectively, reported complete understanding of ACP following their discussion with the APP. Among patient care goals ranked as “extremely important” were “spending quality time with family and friends” (82% and 100%) and “pain control” (76% and 53%).
Furthermore, willingness to complete advance directive documents on the same day that the ACP was conducted was expressed by 65% of participants in inpatient settings and 37% in outpatient settings. Although there were increases in the numbers of patients in both settings completing OOHDNR forms following ACP, the differences were not statistically significant for either set of patients.
Study limitations mentioned by the authors were the small study sample size and the potential for selection bias.
In their concluding remarks, the study authors commented that “the introduction of ACP and subsequent discussions would be appropriate for APPs to incorporate into their daily practice of caring for patients with advanced cancer.”
Goswami P, Mistric M, Barber FD. Advance care planning: Advanced practice provider-initiated discussions and their effects on patient-centered end-of-life care.Clin J Oncol Nurs. 2020;24(1):81-87.