Nurse practitioners (NPs) account for more than 600 million medical office visits per year in the United States. NPs are in a crucial position to educate, advocate, and support the completion of advance directives (Hinders, 2012). Low completion rates of advanced directives directly result in a higher level of Medicare spending, higher likelihood of in-hospital deaths, lower utilization of hospice care, and decreased quality of life (Splendore & Grant, 2017). As a whole, Americans are living longer and healthcare costs increase with age. Investigation of Medicare data conducted by the Kaiser Family Foundation found that Medicare spending rises with age and peaks at age 96. Out of pocket cost for patients at age 96 is $16,145, and this figure is more than double the per capita spending at age 70 ($7,566) (Morrison, 2015). Care in the last year of life has been estimated to be approximately $71,517 (Teno & Gozalo, 2014). Data supports that utilization of hospice drastically reduces healthcare costs, and could offer a savings of $9,000 per patient (Teno & Gonzalo, 2014). Advanced directives increases prevalence of patients choosing less invasive and intense treatments in the end of life. Education facilitates patients’ understanding hospice and end of life care, ensuring informed decisions regarding care they desire to receive.
Significance: The purpose of this quasi-experimental, pretest- posttest design project was to determine if the virtual webpage based advanced directive intervention increased legal documentation and completion rates in healthy adults. The inquiry was, in healthy adults without terminal diagnosis, did an interactive webpage based advanced directive counseling and education program compared to current practice, improve legal documentation and completion rates during a 3-month period in Missouri residents? United States completion rates for advance directives are low at about 18-36% of all adults (Hinderer & Lee, 2014). Community education specifically lacks an abundance of studies, but the studies that do exist support the efforts as successful. Multiple studies discussed the need for additional studies to compare existing resources, multi modal methods, and the most appropriate setting. Virtual settings can allow for more patients to participate in the education efforts that often require extended time, that appears unreasonable for the outpatient office setting. The data suggests that a group setting is evidenced to be successful, but it is also crucial to allow each participant time to ask questions and have one on one counseling if desired.
Methods: An interactive webpage was developed to guide patients through education on the topic, including important points in the decision making process. Participants included adults over the age of 18, without a terminal illness diagnosis and with or without current advanced directives. The goal was to obtain at least 110 participants through convenience sampling. The intervention was accessed by participants from home or other convenient location and was based on materials from the PREPARE for your Care program (Sudore, 2017). The Advanced Directive Engagement Survey was utilized as a measure of readiness for advance care planning. The 34-item version of the survey has Behavior Change Process measures. The Behavior Change Process score was reported as an overall 5-point Likert score. The Behavior Change Process measure has validated sub-scales of knowledge, self-efficacy, and readiness reported. Advanced directive paperwork was downloadable at the conclusion of the educational intervention. A follow up survey was collected at three months’ post intervention. Outcomes included improved advanced directive completion, which was measured by self-report. Completion needed to include legal notarization of the documents.
Results: This presentation will discuss the projects outcomes, including advanced directive completion status, and data from the Advanced Directive Engagement survey. The anticipated results support that providing education about advanced directives assists patients to recognize the need for documents and to legally complete the paperwork.
Discussion: Increasing the prevalence and number of individuals who have advanced care planning conversations and documentation can improve care provided to patients and client satisfaction. Improving completion rates of advanced directives has been acknowledged as a national priority and continues to be the subject of several healthcare practice, policy, and research initiatives (Enguidanos & Ailshire, 2016). Nurse practitioners are positioned to educate patients and continue to improve these rates, in turn improving patient centered care and increasing satisfaction.
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