NURSE-LED ADVANCE CARE PLANNING IN PRIMARY CARE FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

Advance care planning (ACP) can ensure people receive the care they value and prefer when they cannot speak for themselves, yet ACP participation is low. There is a need to identify an approach to the ACP process that promotes participation in high-quality ACP. Utilizing primary care nurses is one ACP engagement approach. Our pilot study sought to determine the feasibility and acceptability of ACP in primary care by nurses with older adults with multiple chronic conditions. The intervention involved two sessions between the nurse and patient that lasted approximately one hour each. Between the two sessions patients were requested to discuss their values, life goals and treatment preferences with family members. Patients completed the ACP Engagement Survey before and after the intervention. Individual interviews were also conducted with the patients and nurses. The majority of patients invited to participate agreed (41/67; 61%). The average participant was 66.2 years old with 9.6 diagnoses. The majority (61%) were female and White/non-Hispanic (98%). All but one of the 41 completed the intervention. Both process and behavior scores on the ACP Engagement Survey improved. Patients and nurse interviews indicated that they were satisfied with the intervention. Thirty-six of the 41 subjects (87.8%) completed an Advance Directive; all 41 identified a healthcare proxy decision maker. ACP conversations between nurses and patients in primary care are feasible and acceptable. Further study is warranted and would benefit by exploring the early impact of ACP conversations on subsequent treatment decisions made by older adults with multiple chronic conditions.