Nurse-Led Patient-Centered Advance Care Planning in Primary Care

Advance care planning rates remain low, indicating a need to identify an approach that promotes acceptance of, and participation in, high-quality advance care planning by clinicians, patients, and families. A pilot study was conducted to evaluate the feasibility and acceptability of a nurse-led advance care planning intervention in primary care, comparing 4 advance care planning decision aids to help patients consider options; a 4-arm, prospective, comparative design was used with scripted discussions between 4 nurses and 40 patients in a large Midwestern clinic. The study procedures were determined to be feasible and acceptable. Most invited patients agreed to participate (40 of 66, 60%); 38 of 40 completed the intervention. Overall, patients and nurses were satisfied with the intervention. Changes in scores on the engagement survey were positive, indicating improvement across all groups. According to these preliminary data, 124 patients would be required in each group for a fully powered study. In addition, 34 of 40 patients (85%) completed an advance directive; all 40 patients identified a healthcare agent. The use of nurses to facilitate advance care planning with patients may be an opportunity to improve healthcare and patient outcomes and support full-scope nursing practice in primary care settings.