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Advance care planning, advance directives, older adults, primary care providers, primary care setting, end-of-life



  1. Solis, Guillermina R. PhD, FNP-C, GNP-C (Assistant Professor)


Background and purpose: The purpose of this literature review was to evaluate strategies used in primary care settings to initiate advance care planning (ACP) conversations leading to the completion of an advance directive (AD). Approximately 50% of older adults have an AD; few talk to their primary care provider (PCP) about end-of-life wishes. The Institute of Medicine report and recent changes in Medicare reimbursement policies create opportunities for PCPs to address ACP in primary care settings.


Methods: We used a systematic review approach. The search included seven Elton B. Stephens Company databases, limited to English language and peer-reviewed publications from 1991 to 2017 using 10 key words.


Conclusions. Effective interventions were educational materials using various methods of delivery, computer-generated triggers for PCPs, inclusion of multidisciplinary professionals for content delivery, and patient preparation for PCP visit.


Implications for practice: The identified strategies provide a starting point for PCPs to consider increasing the ACP discussion with their patients. Primary care providers must create opportunities to meet the needs of their patients and their families. Established guidelines and reimbursement for ACP challenge PCPs to identify and contribute to the formulation of best practices to facilitate AD completion in primary care settings.