2018 TNA and TSNA Joint Annual Conference

2018 TNA-TSNA JOINT CONFERENCE | ADVOCACY IN ACTION
Anna Harty (Co-Presenter)
Kaitlyn McGowan (Co-Presenter)
Caitlyn O’Neil (Co-Presenter)
Jordan Reed (Co-Presenter)
Mary Spitler (Co-Presenter)
Problem Addressed:
2017 study conducted by Honoring Choices Tennessee found that fewer than a third of adult Tennesseans
reported having documented Advanced Care Plans (ACPs). More specifically, a 2016 study conducted by
Vanderbilt University Medical Center showed that 55% of adult patients polled had advance directives.
However, only 24% reported giving a copy to their care provider (Vanderbilt Patient & Family Affairs
Survey, 2016). A review of the literature reveals that patients, caregivers, healthcare providers and the legal
system encounter multiple barriers in developing and documenting these important decisions, including:
knowledge deficits, limited access to affordable legal counsel, inadequate clinic time and discomfort with
discussing these issues.
Objectives:
• Pilot a Medical-Legal Partnership (MLP) between Vanderbilt nursing and law students at the Vanderbilt
Internal Medicine Clinic
• Collaborate with VUMC patient affairs and education on recruitment materials
• Counsel 100% of interested patients on ACPs/POAs during a primary care visit
• Assist 65% of the clinic’s patients to complete new and/or update existing ACP/POA
• 50% of completed ACPs/POA will be returned by the patient and uploaded in the electronic health
record (EHR)
Methods/Procedures:
Nursing and law students, underwent intensive training related to ACP, POA, end of life issues, and how
to screen for other potential health-harming legal needs. Under direct supervision from faculty, students
counseled and provided assistance with the completion of ACPs and/or POAs for patients receiving care at
the Vanderbilt Internal Medicine Clinic. Patient encounters (in person and via phone) were documented via
REDCap – a research-based and HIPAA-compliant database. Completed ACPs/POAs were uploaded into
the patient’s EHR via EPIC.
Findings:
Final outcomes of this project are still in process as of submission of this abstract. To date, the majority
(>60%) of patients were receptive to having conversations with the students about ACP in the primary
care setting. After being provided with information and the ACP document, >75% of patients indicated a
desire to discuss with family members and complete the form at home. A smaller percentage of the patients
reported having already completed ACPs; however, a concurrent review of the EHR revealed many of these
patients’ documents were not on file. This discrepancy, in part, may be attributed to a recent change over to
a new EHR. An unanticipated finding showed younger patients (< 65 years of age) also to be interested in
completing ACPs.
Recommendations for Practice/Research:
The evidence-based literature indicates many healthcare providers are uncomfortable having conversations
about advance care planning and end of life care. However, the majority of patients polled desire to have
these conversations with their primary care provider. Clinicians would benefit from training on how best to
initiate these conversations with patients. Care teams, including social workers and lawyers, should undergo
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