End of Life Care: A Quality Improvement Project

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Cranston, Shelby
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Today people are living much longer lives with life expectancy at 78.8 years old and developing multiple chronic illnesses, which account for 7 out of 10 deaths per year. Advance directives and advance care planning have been widely promoted as the solution to end of life care, however 70% of Americans do not have an advance directive. Previous studies and policies discuss the importance of advance directives and educating patients, but few address the question of why advance directives are not being completed. Literature has shown there are many different barriers and factors that make advance care planning difficult to achieve. Primary care clinics can be an entry point to starting discussions about advance care planning. Investigating the role of primary care clinics in the advance care planning process is important to improving patient care. The setting for this study was a rural clinic in Iowa. The sample was a convenience sample of 75 patients' ages 65 and older. The design of the study included a retrospective chart review, identifying the current workflow of the clinic in collecting and documenting advance directives, an educational brochure, and education of staff and providers regarding advance care planning. From the retrospective chart review 25% of patients had an advance directive in their chart. Of the 75 patients only 5% had documented advance care planning conversations in their chart. Patients with completed advance directives had higher number of comorbidities and medications compared to patients who did not have an advance directive completed. Staff's understanding increased regarding knowledge of all types of advance care planning from 77% to 100%. A uniform process was identified for asking and obtaining advance directives in the primary care clinic. Overall there has been an increased awareness and knowledge of advance care planning among the providers and staff at the primary care clinic.
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