My Life, My Way: A Quality Improvement Program to Increase Advance Care Planning in a Racially and Ethnically Diverse Patient Population

J Pain Symptom Manage. 2020 Jan;59(1):147-151. doi: 10.1016/j.jpainsymman.2019.10.015. Epub 2019 Oct 23.


Background: A multilevel quality improvement program was implemented at an urban community hospital, serving a racially and ethnically pluralistic patient population, to increase participation in advance care planning (ACP).

Measures: Number of eligible patients who completed an ACP form.

Intervention: Projects were implemented over the course of two years that targeted patients, health care providers, the organization, and the community.

Outcomes: The intervention resulted in increased completion of four unique ACP forms. Completion of the Living Will increased by 60%, Health Care Proxy increased by 9%, Medical Orders for Life-Sustaining Treatment increased by 5%, and Do-Not-Resuscitate/Do-Not-Intubate orders increased by 3%.

Conclusion: Multilevel interventions can increase ACP participation in a racially and ethnically pluralistic patient population.

Keywords: Intervention; advance care planning; cultural competency; end-of-life planning; quality improvement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Care Planning*
  • Advance Directives*
  • Cultural Competency*
  • Health Personnel
  • Humans
  • Quality Improvement*