Advance Care Planning: Understanding Clinical Routines and Experiences of Interprofessional Team Members in Diverse Health Care Settings.
BACKGROUND
Interprofessional health care team members consider advance care planning (ACP) to be important, yet gaps remain in systematic clinical routines to support ACP. A clearer understanding of the interprofessional team members' perspectives on ACP clinical routines in diverse settings is needed.


METHODS
One hundred eighteen health care team members from community-based clinics, long-term care facilities, academic clinics, federally qualified health centers, and hospitals participated in a 35-question, cross-sectional online survey to assess clinical routines, workflow processes, and policies relating to ACP.


RESULTS
Respondents were 53% physicians, 18% advanced practice nurses, 11% nurses, and 18% other interprofessional team members including administrators, chaplains, social workers, and others. Regarding clinical routines, respondents reported that several interprofessional team members play a role in facilitating ACP (ie, physician, social worker, nurse, others). Most (62%) settings did not have, or did not know of, policies related to ACP documentation. Only 14% of settings had a patient education program. Two-thirds of the respondents said that addressing ACP is a high priority and 85% felt that nonphysicians could have ACP conversations with appropriate training. The clinical resources needed to improve clinical routines included training for providers and staff, dedicated staff to facilitate ACP, and availability of patient/family educational materials.


CONCLUSIONS
Although interprofessional health care team members consider ACP a priority and several team members may be involved, clinical settings lack systematic clinical routines to support ACP. Patient educational materials, interprofessional team training, and policies to support ACP clinical workflows that do not rely solely on physicians could improve ACP across diverse clinical settings.
1 Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Kelly
K
Arnett
2 Division of Geriatrics, University of California, San Francisco, CA, USA.|3 San Francisco VA Medical Center, San Francisco, CA, USA.
Rebecca L
RL
Sudore
1 Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
David
D
Nowels
4 School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Cindy X
CX
Feng
5 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.|6 Denver-Seattle Center for Veteran-centric and Value-driven Research (DiSCoVVR), Denver, CO, USA.
Cari R
CR
Levy
5 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.|7 Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA.
Hillary D
HD
Lum
D032722:Advance Care Planning / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D003142:Communication; D003430:Cross-Sectional Studies; D004282:Documentation; D057286:Electronic Health Records / Q000458:organization & administration*; D004777:Environment; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000458:organization & administration; D057766:Policy; D024382:Professional Role; D012111:Residence Characteristics; D057188:Workflow
advance care planning; health care team; interprofessional; long-term care; primary care; survey