Evaluating a Clinical Chaplain Pilot Intervention to Facilitate Advance Care Planning in a Primary Care Clinic

Background While advance care planning (ACP) conversations align an individual's healthcare options to their goals, primary care physicians (PCPs) often have limited time and training to conduct ACP in clinic. A clinical chaplain's unique expertise may provide targeted support to help overcome these barriers by assessing the complex dynamics around ACP for patients and providers alike. Objectives Assess the feasibility and impact of a chaplain pilot intervention to facilitate ACP between PCPs and patients. Design This pilot quality improvement study was conducted at an urban academic primary care clinic in the Southeastern United States. Participants Two hundred and six patients at high risk of hospitalization, determined by an institutional algorithm, were assigned to either intervention or control groups. Intervention For each intervention patient, the chaplain reviewed their chart through a pastoral "empathetic, holistic, and relational framework" to (1) determine patient-specific ACP needs and barriers, and (2) complete targeted next steps to facilitate ACP with the PCP. Main Measures Feasibility outcomes were measured using the RE-AIM framework. ACP documentation metrics were compared between study arms before and 6 months after intervention. Key Results The chaplain determined that 75 out of 92 (82%) intervention patients needed additional ACP conversations. Average chart review time was 10 min (range 5-25). The chaplain contacted 62 PCPs and 11 patients, requested 26 appointments, and coordinated 19 interdisciplinary consultations. Compared to controls, intervention patients had a significant increase in ACP notes (35 vs. 2, p = < 0.001), healthcare power of attorney forms (9 vs. 2, p = 0.02), and advance directive forms (6 vs. 0, p = 0.01) after the intervention. Conclusions A clinical chaplain's unique training and experience may provide feasible and worthwhile support to help identify patient-specific needs and barriers and facilitate ACP conversations between PCPs and high-risk patients.