Advance care planning (ACP) offers patients and providers the opportunity to plan for future health care needs. Primary care is an ideal setting for ACP, due to the close relationship patients have with primary care providers (PCP). However, rates of ACP in primary care are relatively low. The purpose of this Doctor of Nursing Practice (DNP) project was to explore barriers to ACP at UNC Family Medicine (UNCFM), a primary care clinic serving a large and diverse patient population, and collaborate with stakeholders to improve ACP in this practice.

Clinic stakeholders participated in interviews based on the Ottawa Decision Support Framework. Notes from 17 interviews were analyzed for themes. The most frequently cited barrier was lack of knowledge about ACP; therefore, an educational ACP guide was developed and presented to three PCPs in an hour-long didactic session. ACP billing codes were compared before and after the education session to determine whether education increased rates of ACP.

ACP billing increased very slightly from an average of 0 ACP conversations per provider per 30 days pre-intervention to 0.3 ACP conversations per 30 days post-intervention. In conclusion, education did not yield a significant increase in ACP billing. Lack of a clinical workflow for ACP hindered providers' ability to conduct ACP. Provider education is a first step, but multiple other interventions are needed to increase ACP rates in primary care.