Advance care, advance directives, end of life, Five Wishes, planning, primary care, practice change



  1. Atherton, Kahla N. DNP, APRN, FNP-BC (Primary Care Provider)


Background: Despite the widely known and well-established benefits of advance care planning, it is estimated that 15-30% of American adults have completed advance directives (ADs). Evidence suggests that the best place for advance care planning (ACP) is in primary care, but many barriers to this practice exist.


Local problem: Providers in a Northern Arizona private practice primary care clinic expressed frustration with their current ability and standard of care regarding ADs. Only 0.8% of their established adult patients had ADs.


Methods: Project Five Wishes was a 16-week trial designed to increase the number of ADs recorded at a Northern Arizona primary practice. The secondary purpose was to increase primary care provider knowledge, comfort, confidence, perceived importance, and frequency of discussions about ADs with patients.


Interventions: Interventions used in this project aimed to eliminate common barriers to ACP through a 30-minute presentation for providers and by integrating a user-friendly AD form into the office workflow.


Results: The number of ADs recorded increased by 25.4%. There were no statistically significant changes in the providers' reported knowledge, comfort, confidence, perceived importance, and frequency of discussions regarding ADs.


Conclusions: The feasibly reproducible process used in Project Five Wishes was successful at increasing the number of patients with ADs in this 16-week trial and could lead to improvement in this area for other clinics as well.