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Strategies used to facilitate the discussion of advance care planning with older adults in primary care settings

A literature review

Solis, Guillermina R. PhD, FNP-C, GNP-C (Assistant Professor)1; Mancera, Bibiana M. PhD (Community Engagement Director)2; Shen, Megan Johnson PhD (Assistant Professor)3

Journal of the American Association of Nurse Practitioners: May 2018 - Volume 30 - Issue 5 - p 270–279
doi: 10.1097/JXX.0000000000000025
Review - Systematic
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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.

1School of Nursing, The University of Texas at El Paso, El Paso, Texas,

2Border Biomedical Research Center, The University of Texas at El Paso, El Paso, Texas,

3Department of Medicine, Weill Cornell Medicine, New York, New York

Competing interests: The authors report no conflicts of interest.

Authors' contributions: G.R. Solis: conceptualized, designed, and drafted the manuscript with the contribution of coauthors. B.M. Mancera: assisted with the design, selection, and analysis of the literature as well as developing drafts and the final manuscript. M.J. Shen: provided assistance in the content, design, and preparation of the manuscript.

Received July 17, 2017

Received in revised form December 21, 2017

Accepted December 27, 2017

© 2018 American Association of Nurse Practitioners
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