Abstract
Background: Advance care planning (ACP) supports patient autonomy and promotes care aligned with individual values and preferences. Despite these benefits, fewer than half of adults aged 50–80 have completed formal ACP documentation, and community-dwelling older adults rarely engage in ACP before serious illness, representing a persistent gap in early engagement.
Purpose: This quality improvement (QI) project evaluated the effectiveness of a community-based ACP educational intervention in improving ACP knowledge, confidence, and engagement among older adults.
Methods: A nurse facilitator trained in the Five Wishes framework delivered a structured, 60-minute ACP workshop at a senior center in North Texas. A pre–post design was used to assess changes in ACP confidence immediately following the intervention, with a six-week follow-up survey evaluating self-reported ACP behaviors. Descriptive and comparative analyses were conducted to examine changes over time.
Results: Forty-one participants completed the workshop; 26 (63.4%) completed the six-week follow-up. Nine of ten ACP confidence measures improved significantly post-intervention (all p ≤ .05). At six weeks, advance directive completion increased from 23.1% to 76.9%, and communication with healthcare decision-makers increased significantly across multiple measures. Workshop satisfaction was uniformly high, with 100% of participants reporting they would recommend the workshop to others and zero negative responses across all satisfaction items.
Conclusions: A structured, community-based ACP educational intervention significantly improved confidence and engagement in ACP activities among older adults, demonstrating a feasible and scalable model for promoting earlier ACP engagement in community settings. Findings support nurses as well-positioned leaders of community-based ACP education, with implications for expanding proactive ACP programming across diverse community settings to advance patient autonomy and goal-concordant care.
Date of publication
Summer 7-23-2026
Document Type
DNP Scholarly Project
Language
english
Persistent identifier
http://hdl.handle.net/10950/5094
Committee members
Angie McInnis, DNP, APRN, ENP, FNP-BC, PMHNP-BC
Degree
Doctor of Nursing Practice
Recommended Citation
Hill, Teresa, "DNP Final Report: COMMUNITY-BASED ADVANCE CARE PLANNING EDUCATION FOR OLDER ADULTS: A QUALITY IMPROVEMENT PROJECT" (2026). DNP Final Reports. Paper 91.
http://hdl.handle.net/10950/5094