Use of a simulated group visit to introduce advance care planning in the primary care setting

Abstract

Background and objective: When serious illness prevails or when faced with an end-of-life event, nurses should recognize symptoms and support patients with decision-making. By encouraging advance care planning (ACP) in the outpatient setting, patient involvement is enhanced. Objective: A performance improvement plan was used to increase nurse care manager confidence levels with hosting ACP conversations.

Methods: Design: Care managers attended a two-hour simulated session to observe how to educate and prepare patients to complete advance directives. The session included a video introduction with two different group activities that encouraged sharing experiences from the peer perspective. Options for care were explored, focusing on selecting a health care power of attorney and promoting an end-of-life values conversation. Setting/Participants: The group visit occurs in the outpatient setting in a small group with five nurse care managers in the first visit and nine nurses in the second visit. Measures: Using a Likert scale, a pre/post-visit survey was given with eight questions to measure confidence levels with ACP in the group visit setting. Follow-up interviews were voluntarily conducted to measure confidence in completing an ACP conversation with a friend or family member.

Results: Eight of the fourteen care managers participated in the post-visit interviews. 63% expressed themes of increased comfort in understanding and sharing ACP steps. The overall mean for pre/post survey confidence level increased from 3.77 to 4.33 (S.D. 0.25), with the most significant increase centered around confidence to lead a values conversation to select preferences for care.

Conclusions: This performance improvement plan to promote ACP in the outpatient setting aligns with past studies promoting a group visit to educate and prepare patients to complete advance directives. Although findings may have limited generalizability, due to their small sample size, future group visits should be considered as a possible solution to meet busy time constraints in the primary care office.