Advance care planning in patients with heart disease: A practice improvement initiative

Abstract

<p><strong>Background:</strong> Despite cardiovascular disease being the number one cause of death, advance directives are infrequently used in this population. The Patient Self- Determination Act (PSDA) took effect in 1991 to protect patients&rsquo; autonomy and limit unnecessary suffering. Although hospitals fulfill the required PSDA documentation, patients lack understanding of advance directives, and physicians infrequently use Advance Care Planning (ACP). Health Care Proxy (HCP) is the essential first step in ACP.</p> <p><strong>Purpose: </strong>The purpose of this study is to examine the effect of a nurse practitioner-led promotion of ACP for hospitalized adult patients.</p> <p><strong>Theoretical Framework:</strong> The Shuler Nurse Practitioner Model and the Self- Determination Theory informed this study. The nurse practitioner is uniquely positioned to facilitate the patient&rsquo;s autonomy through Shuler&rsquo;s approach.</p> <p><strong>Method:</strong> A longitudinal case-control design was used to study the effect of nurse practitioner-led promotion of ACP in a convenience sample (n=120) of hospitalized patients with cardiovascular disease. In addition to the current practice, a nurse practitioner educated and encouraged patients to identify and document a HCP. Medical records of patients admitted prior to initiating the intervention (n=60) was compared to those receiving the intervention (n=60). HCP completion rate was the outcome of interest. A chi-square analysis was used to examine the effectiveness of the intervention.</p> <p><strong>Results:</strong> There is significant relationship between NP intervention and new HCP completion (Chi-square = 86.769, df = 1, p &lt; 0.05). Patients were more likely to complete HCP when there is an NP-led ACP intervention. Prevalence of HCP improved from 35% in controls to 90% in cases.</p> <p><strong>Implications: </strong>Findings suggest nurse practitioners are effective in identifying and leveraging opportunities to facilitate ACP communication. Health care professionals are urged to empower patients to take full advantage of their self-determination.</p>