IMPLEMENTATION OF ADVANCE CARE PLANNING (ACP) VIDEO IN A PRIMARY CARE SETTING
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2020
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Background: One of the great tragedies of American healthcare is the delivery of unwanted medical care at the end-of-life (EOL) (Institute of Medicine, 2014). Planning for EOL care has been viewed as a public issue given that only 26% of Americans have completed an advance directive (AD) (Yadav et al., 2017). The use of video decision tools may help address this public concern and increase AD completion rates.
Purpose: The purpose of this quality improvement project was to evaluate the efficacy of video decision aids in increasing AD completion rates and facilitating the ACP education process at an ambulatory clinic in Honolulu, Hawaii.
Methods: Adults patients aged 65 years old or older were offered an opportunity to watch an ACP video during their annual wellness visit (AWV). An ACP code log was reviewed to determine AD completion rates among the participants. A satisfaction survey was completed to evaluate staff perspective regarding the impact of videos in their education process.
Results: A total of 148 participants were offered an opportunity to watch the ACP video during the 20-week implementation period. Only 5.5% (5 of 91) of the participants who viewed the ACP video completed an AD. In comparison, 7% (4 of the 57) participants who deferred the videos completed an AD. Staff were highly satisfied with educational tool.
Conclusion: Findings suggest that ACP videos can facilitate the health care education process but having patients complete a written document remains a challenging task. In order to maximize the benefits of video tools, additional work is needed to refine the workflow process and address existing barriers to completion of an ACP. Besides video intervention, exploring other theoretical models and strategies such as a community-based approach may produce more favorable outcomes.
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Nursing, Gender studies, AD completion, advance care directive, documentation rates, end-of-life care, video decision aids, video tools
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62 pages
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