Increasing Advance Care Planning and Outpatient Palliative Care Referral Rates in Primary Care

Background: Worldwide, approximately 14% of individuals who need palliative care (PC) services are currently receiving PC and only 30% of Americans have an Advance Care Plan (ACP). Local Problem: There is a decreased awareness among policy-makers, healthcare providers, and the public about PC services and benefits, which results in the underutilization of this service. This project aimed to connect patients at Tanner Clinic-Westside (TCW) with ACP and outpatient PC services. Methods: The Theory of Planned Behavior was used as a guiding framework for the educational intervention. Project outcomes were evaluated through a pre- and post-educational intervention questionnaire to PCPs at TCW to identify and compare perceived behavior controls, subjective norms, attitudes, and barriers associated with ACP and outpatient PC referrals. The project also monitored for appropriately documented PC referrals and conducted post-project interviews to learn additional views and experiences affiliated with this project. Interventions: The intervention included a training and clinical pathway for primary care providers (PCP) at TCW to perform ACP. The educational intervention included on-sight training, consultation, and resources for PCPs at TCW about ACP and outpatient PC. Results: Post-educational intervention, there were no significant differences identified when comparing pre- and post-educational intervention questionnaire responses. However, there were some changes noted when examining the descriptive comparison of the results which suggested a modest improvement from pre- to post-findings in providers' perception of having adequate time to discuss ACP and in their comprehension of how to properly document ACP. Evaluation of the electronic health record system to identify changes in properly documented outpatient PC referrals displayed no proper documentation 6 weeks before the intervention and one properly documented PC referral 10 weeks post-intervention. The interview results revealed that post- educational intervention, providers felt that the project made it easier for them to conduct ACP discussions due to improved comprehension and also provided a good reminder to conduct ACP discussions. Conclusion: This project encouraged ACP and PC for patients through the creation and implementation of an educational intervention for PCPs at TCW. The post-project interview results suggested that the project provided a good reminder for PCPs to conduct ACP discussions and increased their knowledge associated with ACP and PC services.