Development of a Physician Resource Packet to Assist With Advance Care Planning in an Ambulatory Primary Care Setting

Advance Care Planning (ACP) involves a process of understanding, planning for, and interpreting complex, often difficult, healthcare choices based on personal preferences and values for future healthcare needs.  ACP includes documentation in an advance directive (AD), designation of a healthcare decision-making proxy, and multiple conversations to understand and update the patient’s goals of care.  Empirical data shows that patients want ACP conversations to be initiated by their healthcare provider prior to or in early stages of disease onset and in the primary care setting.  Despite documented benefits of AD and ACP, rates of documented AD in the general population remain low and have been associated with provider barriers to having ACP conversations.  This study aimed to expand on existing data to determine provider barriers to offering ACP in an ambulatory setting and preferences for reducing those barriers.  Qualitative methodology in the form of a focus group discussion was conducted with providers from a small primary care practice affiliated with an academic medical center in Philadelphia, PA.  Thematic analysis of the focus group data showed three main barriers to providers: time, physician logistical concerns, and discomfort.  Overarching themes were divided into sub-themes and approaches to reduce barriers.  Data from the focus group, in conjunction with materials and methods from current best practices, were used in the development of provider resources aimed at increasing and enhancing provider-patient ACP conversations.  Results from this study also provide specific areas to target for future interventions at the patient, provider, and organizational levels.