Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Julie A. Koch


Despite the passage of the Patient Self-Determination Act in 1992, only 15% of the United States population has completed an advance directive (AD). This statistic will be exaggerated with the future growth of older adults in the year 2030, at which time this portion of the population is expected to double to 72.1 million people. Without an AD, patients lose their autonomy and may be subjected to costly, life prolonging treatments that they would never choose for themselves. The unnecessary costs and unwanted treatment are preventable with an AD, and primary care providers are in a prime position to initiate AD discussions when patients are in good health and capable of making these decisions. Evidence suggests that if primary care providers and office staff were trained in patient advance care planning (ACP) and provided an AD guideline to follow, then heath care providers would engage in patient AD discussions. Thus, the purpose of this evidence based practice (EBP) project was to determine whether an AD Engagement Protocol which focused on patient’s level of AD readiness, along with health care provider and office staff education, impacted staff attitudes and promoted engagement of AD discussion at the EBP target site. To guide this EBP project system change, the Stetler Model and the Transtheoretical Model were utilized. Patient demographic data were collected and the engaged patient’s level of readiness was assessed per provider. Attitudes were measured using the tool, A Brief Survey About Staff Attitudes Related to Advanced Directives. Data analysis was completed using descriptive statistics, and paired t-tests identified the differences in provider and staff attitudes about ADs before and after project intervention. Attitudes about ADs improved to a statistically significant level post-intervention (p = .0004). All health care providers positively engaged in ACP discussions with eligible patient participants at a rate exceeding 50%.