Date of Publication


Project Team

Jason Garbarino, D.N.P., RN-BC, CNL; Kate Wageman, FNP



Completion of Advance Directives (AD) continues to be low nationwide, with only 30% of all Americans completing their advance directive (CDC, 2018). This quality improvement project aimed to increase the completion rate of advance directives by 10% in a target number of adult patients aged 50 and older who did not have an AD at a primary care facility.


A plan-do-study-act (PDSA) cycle was done with five patients resulting in newly defined inclusion criteria and modification of interventions. 31 patients who met inclusion criteria were given a packet containing a cover letter, instruction sheet, written information about AD from Vermont Ethics Network, and a pre-postage/pre-labeled envelope. Patients received calls within one week after their office visits to provide follow-up support with their AD. The percentage of completed ADs returned to the office after providing follow-up support was calculated.


In total, 23% (7) of patients returned their completed AD form, which was then uploaded to their EMR. Only 29% (9) of patients were reached with follow-up calls. 100% (2/2) of patients who requested follow-up support completed their AD. 33% (3/9) of patients that answered the follow-up call returned their completed AD to the office, whereas 18% (4/22) of patients that were left Voicemails (VM) completed their AD.


This study did not significantly impact the completion rate of AD with only a 5.3% increase in completion rate. Prior to the intervention, the completion rate of AD was 23.7%. A persistent challenge for this study was getting in contact with patients. Recommendations for future study include increasing awareness of AD among patients and providers, investing in designated ACP staff on site, and embracing avenues to increase AD completion rate in primary care.

Document Type


Available for download on Thursday, May 01, 2025