ArticleJournal of general internal medicine2026
Trainee-Led Patient Education to Increase Advance Care Planning in a Geriatric Primary Care Clinic.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
8 authors.
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Abstract
backgroundAdvance care planning (ACP) is critical for communicating patients' preferences for future medical care, especially in geriatric populations. Despite the acknowledged importance, completion rates remain low.
objectiveWe aimed to increase ACP in a geriatric primary care clinic (geri-PCC) using a trainee-led educational intervention.
designRetrospective analysis of a quality improvement intervention.
participantsIn total, 498 patients, > 60 years old with no advance directives (AD) or Portable Medical Orders (POLST) were seen in the geri-PCC during the intervention period. Sixty-five received the intervention while 433 did not.
interventionWe incorporated an ACP education session led by medical trainees into the geri-PCC workflow 3/2023-4/2023. MAIN MEASURES: New AD (includes durable power of attorney for healthcare (dPOA) and Living Will (LW)) and POLST captured in the EMR, ICD-10 codes billed for ACP/goals of care (GOC) were compared between the intervention and standard care groups during 6 months following the intervention period. Secondary logistic regression analyses adjusted for age, gender, mood disorder, and cognitive impairment when evaluating the intervention's association with primary outcomes. KEY
resultsThe intervention group had more new dPOA forms (13.8% vs 5.3%, p = 0.025) and ACP/GOC codes (32% vs 13%, p < 0.001). These findings remained significant after adjusting for age, gender, mood disorder, and cognitive impairment (dPOA OR = 2.96, 95% CI 1.24-6.59, p = 0.010; ACP/GOC OR 3.07, 95% CI 1.67-5.52, p < 0.001). Cognitive impairment was associated with more completion of POLST (OR = 3.29, 95% CI 1.15-11.0, p = 0.035) but less completion of LWs (OR = 0.34, 95% CI 0.13-0.79, p = 0.018).
conclusionsIncorporating an ACP education session led by medical trainees was associated with increased AD documentation in the EMR and increased ACP/GOC codes billed in our geri-PCC. The emergence of cognitive impairment as a predictor of POLST completion needs further exploration.
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