A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care

Abstract

Introduction: Group visits for advance care planning (ACP) may help patients document preferences for decision makers and future care. We assessed the impact of a primary care-based ACP group visit (ACP-GV) intervention on older adults' ACP documentation and why patients participated.

Methods: Older adults (>65 years) in primary care participated in a 2-session ACP-GV intervention that promotes group dynamics, peer-based learning, and goal setting. Charts were reviewed at baseline, 3 months, and 12 months for documentation of decision makers and ACP forms. We described patients' reasons for participating through analysis of transcripts.

Results: 118 patients (mean age 76 years; 62% female and 82% white) participated in 16 ACP-GV cohorts. From baseline to 3-month follow-up, documentation of decision maker preferences increased from 39% to 81%, and was 89% at 12-month follow-up. Patients with completed ACP forms increased from 20% to 57% at 3 months, and was 67% at 12 months. Reasons for participating included recognizing the importance of ACP, curiosity, participation recommended by primary care provider, desire to talk with family/friends, and desire to complete advance directives.

Conclusions: This ACP-GV intervention increased ACP documentation among patients with diverse reasons for participating. This is a patient-centered approach to ACP in primary care.

Keywords: Advance Care Planning; Advance Directives; Decision Making; Documentation; Palliative Care; Patient Appointments; Primary Health Care.

Conflict of interest statement

Conflict of interest: Dr. Sudore and University of California San Francisco Regents licensed PREPARE for use in this clinical demonstration project.

© Copyright 2017 by the American Board of Family Medicine.

Figures

Figure 1

Design for the advance care planning group visit intervention. This flowchart provides an overview of patients (n = 118) and nonparticipants (n = 385) who were referred for the intervention. At baseline, participants were scheduled for two 2-hour group visits, 1 month apart, with follow-up at 3 and 12 months. *One patient missed the first session but desired to participate in the second session. EMR, electronic medical record.

Figure 2

Documentation of advance care planning (ACP) among group visit participants (n = 118) at baseline and the 3- and 12-month follow-ups. Patient documentation of surrogate decision makers and ACP forms at baseline and at 3 and 12 months. The comparisons of baseline versus 3 months and baseline versus 12 months are significant at P <.001.

Figure 3

The type of advance care planning forms among group visit participants (n = 118) at baseline and at the 3- and 12-month follow-ups. Specific forms were available in the participants’ electronic medical records. Participants could have >1 type of advance care planning form.