Abstract
BACKGROUND: While advance care planning (ACP) conversations align an individual's healthcare options to their goals, primary care physicians (PCPs) often have limited time and training to conduct ACP in clinic. A clinical chaplain's unique expertise may provide targeted support to help overcome these barriers by assessing the complex dynamics around ACP for patients and providers alike. OBJECTIVES: Assess the feasibility and impact of a chaplain pilot intervention to facilitate ACP between PCPs and patients. DESIGN: This pilot quality improvement study was conducted at an urban academic primary care clinic in the Southeastern United States. PARTICIPANTS: Two hundred and six patients at high risk of hospitalization, determined by an institutional algorithm, were assigned to either intervention or control groups. INTERVENTION: For each intervention patient, the chaplain reviewed their chart through a pastoral "empathetic, holistic, and relational framework" to (1) determine patient-specific ACP needs and barriers, and (2) complete targeted next steps to facilitate ACP with the PCP. MAIN MEASURES: Feasibility outcomes were measured using the RE-AIM framework. ACP documentation metrics were compared between study arms before and 6 months after intervention. KEY RESULTS: The chaplain determined that 75 out of 92 (82%) intervention patients needed additional ACP conversations. Average chart review time was 10 min (range 5-25). The chaplain contacted 62 PCPs and 11 patients, requested 26 appointments, and coordinated 19 interdisciplinary consultations. Compared to controls, intervention patients had a significant increase in ACP notes (35 vs. 2, p = < 0.001), healthcare power of attorney forms (9 vs. 2, p = 0.02), and advance directive forms (6 vs. 0, p = 0.01) after the intervention. CONCLUSIONS: A clinical chaplain's unique training and experience may provide feasible and worthwhile support to help identify patient-specific needs and barriers and facilitate ACP conversations between PCPs and high-risk patients.