Advance Care Directives : A Herzl Clinic Quality Improvement Project

Background: Advance Care Planning has benefits for patients and is often optimal when done in the primary care setting. Unfortunately, it does not occur frequently or routinely. The goal of this project was to understand the challenges and barriers that residents at a Family Medicine training site face in initiating and discussing Advance Care Directives. Methods: An online survey was conducted among 50 Family Medicine residents at the Herzl clinic. Participants were asked about their experience, their comfort level, and their challenges with Advance Care Planning discussions. A focus group with 12 Family Medicine residents further probed, through open-ended questions, the specific challenges they have faced during Advance Care Planning and ideas to address them. Results: The online survey and focus group identified that most residents perceived a lack of time, inadequate training, and poor uptake of available tools as barriers to have Advance Care Planning discussions in a community setting. Residents also felt that patients were inadequately prepared for these discussions. For improvement, most residents suggested to increase the variety of teaching modalities, to dedicate time for these discussions and to prioritize in-person discussions. Conclusion: The residents in Family Medicine face many challenges and barriers to having Advance Care Directives discussions with their patients but were able to provide avenues for improvement.