Starting the conversation: findings from an advance care directive workshop

Abstract Every adult that enters a hospital is asked about an advance care directive (ACD) document. The completion rates of care directives started to grow in 2016, when Medicare provided a reimbursement benefit in the annual wellness exam. Previous data shows only 37% of older Americans have an ACD, of that 64% are white. Previous studies report data from medical visits, however, advance directive discussions conducted in a community setting has not yet been explored. This pilot study examines readiness to have discussions with your appointed decision-maker, primary care provider, and complete ACD document. This was a community workshop with a physician-led presentation regarding medical choices, followed by break-out groups with trained moderators reviewing ACD materials. Data from pre/posttest along with qualitative comments addressing information seeking (pre) and additional comments (post) are included. The workshop increased participants readiness to identify an individual to make medical decisions and put into writing the type of medical care they desire. It also showed resistance to having conversations with a person's primary care provider and chosen health care agent. Challenges included the pre/posttest completion rate and the inability to compare a control group. Viewing advance directive completion within the self-determination theory assists in understanding the need for a novel setting to promote relatedness. Further research needs to be done on community setting ACD workshops to provide a space for participants to be better informed in the ACD process. Community workshops need to be examined to have a broader spectrum of inclusion within historically marginalized communities.