• Bahman Sadeghi, Anne M Walling, Patrick S Romano, Sangeeta C Ahluwalia, and Michael K Ong.
• 1 Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California , Los Angeles, Los Angeles, California.
• J Palliat Med. 2016 Apr 1; 19 (4): 451-5.

BackgroundEarly discussions about advance care planning (ACP) have been associated with improved patient and caregiver outcomes for patients with serious illness. Many patients with heart failure (HF) may benefit from more timely ACP, in part due to the unpredictable trajectory of the disease.ObjectivesThe purpose of this study was to evaluate the feasibility of implementing a multiple-component hospital-based intervention on completion of ACP forms among HF patients.MethodsA brief hospital-based ACP intervention was led by a nonclinician health educator that included (1) an educational video about shared decision making and (2) a protocol to engage HF providers in patients' ACP decision making after the hospitalization. We surveyed patients regarding attitudes toward the ACP intervention and studied completion rates of advance directives (ADs) or physician orders for life sustaining treatment (POLST) forms six months following discharge.ResultsThe educational video component of this intervention was considered helpful by 92% of participants, and 70% said they were more likely to talk with their physician about their end-of-life preferences after watching the video and interacting with the health educator. Of 37 participants, 49% had evidence of completion of an AD or POLST in their medical records six months after the index hospitalization compared to 32% before the intervention. The number of patients having a signed scanned POLST form increased from 10 (27%) before the intervention to 16 (43%) six months after the intervention (p = 0.03).ConclusionsA hospital-based ACP intervention using nonclinician health educators is feasible to implement and has the potential to facilitate the ACP process.

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