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Nurse Navigators Boost Advance Care Planning

FRIDAY, Jan. 29, 2021 -- A nurse navigator in the primary care setting leads to increases in advance care planning (ACP) discussion and documentation, according to a study published online Jan. 11 in JAMA Internal Medicine.

Jennifer Gabbard, M.D., from the Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues randomly assigned vulnerable older primary care outpatients (≥65 years with multimorbidity plus either cognitive or physical impairments and/or frailty) to either a nurse navigator-led ACP pathway (379 patients) or usual care (380 patients).

The researchers found that the nurse navigator-led ACP pathway resulted in a higher rate of ACP documentation (42.2 versus 3.7 percent) versus usual care. Among patients randomly assigned to the nurse navigator-led ACP pathway, ACP billing codes were used more often (25.3 versus 1.3 percent). Those in the nurse navigator-led ACP pathway more frequently designated a surrogate decision maker (64 versus 35 percent) and completed ACP legal forms (24.3 versus 10 percent). During follow-up, results were similar between the groups for incidence of emergency department visits and inpatient hospitalizations (hazard ratio, 1.17; 95 percent confidence interval, 0.92 to 1.50).

"This trial suggests a promising new approach to ACP in the outpatient primary care setting and a potentially scalable approach to ACP for vulnerable older adults," the authors write.

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Posted: January 2021