Filtering by
- All Subjects: Quality Improvement
- All Subjects: Advance Care Planning
- Member of: Doctor of Nursing Practice (DNP) Final Projects
As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental illness and substance abuse, alienation from potential healthcare proxies, and specific fears related to dying. Completion of an advance directive (AD) would address many of these barriers, as well as national goals of reducing medical costs associated with end of life care. A review of the literature indicates that homeless individuals, once educated on the purpose and significance of ADs, complete them at a higher rate than non-homeless people. Further, racial and ethnic disparities in document completion are minimized with educational interventions about an AD’s purpose.
King’s Theory of Goal Attainment provides the theoretical basis for the application of such an intervention in the setting of a medical respite center and a day resource center that both serve the homeless. Thirty-seven clients of the two sites and 14 staff members were administered a pre-and post-test measuring attitudes and knowledge relating to ADs on a Likert scale, resulting in an increase in knowledge about one of the two documents that traditionally comprise an AD, while not significantly affecting attitudes. Implications for practice include an inexpensive intervention that does not require a medically trained individual to deliver, enabling a broad application to a variety of settings with the goal of empowering a traditionally disenfranchised population to make health decisions related to the most vulnerable of life passages.
The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.
The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.