Advance Care Directives: A Herzl Clinic Quality Improvement Project on Patients' perspectives

Background: Advance Care Planning (ACP) has benefits for patients and is often optimal when done in the primary care setting. Despite the development of multiple resources and tools to support ACP discussions at our Family Medicine Teaching Clinic, the initiation and documentation of Advance Care Directives (ACD) in patients’ medical files were low and resident physicians had perceived that patients were unwilling or unprepared for ACP discussions. The goal of this project was to understand the challenges and barriers that patients and their caregivers face in initiating and discussing ACD with their primary care team. Methods: An online survey was conducted among 78 patients who are part of the Home Care program at the Herzl clinic. Participants were asked about the value placed on ACP and their preferences on various aspects surrounding the initiation of ACD discussions. Results: 25 of 78 possible responses were received. This included survey responses from 6 patients, 13 caregivers, 4 family members and 2 physicians. Our results show that patients and their caregivers value Advance Care Planning discussions (>80%). Additionally, they endorse multiple benefits of ACP for themselves, their care teams and families. Patients and caregivers prefer that medical professionals initiate and facilitate the discussions (70-80%) and are open to receive educational material to prepare for these discussions (68%). Conclusion: Patients in a frail population are willing and open to discuss advance care planning with their primary care team. Family Medicine teaching clinics can support patients’ desire to engage in ACP by providing access to education material and initiating these discussions.