Dussault Nicole, Henderson Katherine, Daniel Katherine, Mitchell Nia Michaela, Nickolopoulos Elissa, Hemming Patrick, Casarett David, Cho Alex, Ma Jessica E
Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Department of Chaplain Services and Education, Duke University Health System, Durham, NC, USA.
J Gen Intern Med. 2025 Apr 29. doi: 10.1007/s11606-025-09527-1.
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.
Assess the feasibility and impact of a chaplain pilot intervention to facilitate ACP between PCPs and patients.
This pilot quality improvement study was conducted at an urban academic primary care clinic in the Southeastern United States.
Two hundred and six patients at high risk of hospitalization, determined by an institutional algorithm, were assigned to either intervention or control groups.
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.
Feasibility outcomes were measured using the RE-AIM framework. ACP documentation metrics were compared between study arms before and 6 months after intervention.
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.
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.
虽然预先护理计划（ACP）对话能使个人的医疗选择与其目标保持一致，但初级保健医生（PCP）在诊所进行ACP的时间和培训往往有限。临床牧师的独特专业知识可能会提供有针对性的支持，通过评估患者和提供者在ACP方面的复杂动态来帮助克服这些障碍。
评估牧师试点干预措施在促进初级保健医生与患者之间进行ACP的可行性和影响。
这项试点质量改进研究在美国东南部的一家城市学术初级保健诊所进行。
通过机构算法确定的206名高住院风险患者被分配到干预组或对照组。
对于每位干预患者，牧师通过牧师的“共情、整体和关系框架”审查其病历，以（1）确定患者特定的ACP需求和障碍，以及（2）完成有针对性的后续步骤，以促进与初级保健医生的ACP。
使用RE-AIM框架测量可行性结果。在干预前和干预后6个月比较研究组之间的ACP记录指标。
牧师确定92名干预患者中有75名（82%）需要额外的ACP对话。平均病历审查时间为10分钟（范围为5-25分钟）。牧师联系了62名初级保健医生和11名患者，安排了26次预约，并协调了19次跨学科会诊。与对照组相比，干预患者在干预后ACP记录（35份对2份，p = <0.001）、医疗授权书表格（9份对2份，p = 0.02）和预先指示表格（6份对0份，p = 0.01）有显著增加。
临床牧师的独特培训和经验可能会提供可行且有价值的支持，以帮助识别患者特定的需求和障碍，并促进初级保健医生与高风险患者之间的ACP对话。
