TOPLINE

The incorporation of a brief advance care planning (ACP) education session led by medical trainees was associated with higher odds of completing Durable Power of Attorney for Healthcare forms and billing for ACP-related codes in patients in geriatric primary care. Cognitive impairment was associated with higher odds of Portable Medical Orders (POLST) completion but was linked to a reduced likelihood of Living Will documentation.

METHODOLOGY

• Researchers conducted a retrospective analysis of a quality improvement intervention in a geriatric primary care clinic in New Jersey to evaluate the effectiveness of a medical trainee-led ACP intervention.
• A total of 498 patients older than 60 years with no advance directives or POLST documented in their electronic medical records (EMRs) were included; 65 patients received a trainee-led ACP education session (median age, 80 years; 68% women) from March to April 2023 and 433 received standard care (median age, 81 years; 73% women).
• Medical trainees participated in a 15-minute standardized ACP training session at the start of their rotation and then delivered a 10-minute education session to eligible patients after their office visits, explaining ACP concepts, defining advance directives as documents outlining future medical wishes, providing blank advance directives forms with instructions for completion and return, and offering assistance with completion.
• The outcomes assessed were new Living Will, Durable Power of Attorney for Healthcare, and POLST forms documented in the EMRs, along with codes billed for ACP/goals of care in the 6 months after the patients’ first scheduled visit during the intervention period. The outcomes were compared between the intervention and standard care groups.

TAKEAWAY

• The intervention group had more new Durable Power of Attorney for Healthcare forms than the standard care group (adjusted odds ratio [aOR], 2.96; P = .010).
• ACP/goals-of-care codes were billed more frequently in the intervention group than in the standard care group (aOR, 3.07; P < .001).
• Cognitive impairment was associated with higher odds of completion of POLST forms (aOR, 3.29; P = .035) but lower odds of completion of Living Wills (aOR, 0.34; P = .018).
• Living Will documentation showed a trend toward an increase in the intervention group, but this increase was not significant.

IN PRACTICE

“Using existing structures, such as medical trainees who are motivated to learn and participate, may be a feasible way for primary care clinics to increase ACP,” the authors wrote.

SOURCE

The study was led by Zehra B. Omer, MD, of the Division of Geriatrics at the Hackensack University Medical Center in Hackensack, New Jersey. It was published online on June 30, 2026, in the Journal of General Internal Medicine.

LIMITATIONS

The study was conducted at one primary care clinic with a population of adults older than 60 years, which might not apply to other primary care settings. The intervention relied on having motivated medical trainees involved in the clinic workflow, which may not happen in community settings. The sample size in the trainee-led intervention group was small.

DISCLOSURES

Hackensack Meridian Health resources provided support for this study. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.