Concurrent Sessions

F5 – Integrating Advance Care Planning into Primary Care Teams

Theme 5. Why hasn’t this expanded: scalable pilot programs

  • Date: Thursday, October 25, 2018
  • Concurrent Session F
  • Time: 12:00-12:45pm
  • Room: Harbour C
  • Style: Presentation (information provided to audience, with opportunity for audience to ask question)
  • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
  • Target Audience: Clinical providers

Learning Objectives

Participants will learn:  How to select one of many ACP tools that are already available: An evidence-based approach to advance care planning (ACP)  Strategies to clearly document and track ACP in an EMR  Strategies to incorporate IHPs into ACP discussions  Strategies for educating patients about ACP, including overcoming barriers


There are multiple organizations and agencies that have created tools for advance care planning, but there is little direction about scaling these interventions into primary care offices.   The goal of this presentation will be to outline the approaches to ACP and give direction about how to implement these strategies into primary care delivery within interdisciplinary care teams.

The presenter will offer a back ground of the ACP approach that was implemented, including supporting literature about its efficacy. They will also provide information about how to integrate other team members into the process, including designating a specific team member for in-depth conversations as needed.   Data regarding efficacy and barriers to implementing ACP will also be reviewed based on patient feedback and clinical experience.


  • Meghan Rule, NP-PHC, Bridgepoint FHT


  • Sheena Luck, NP-PHC, Mount Sinai FHT
  • Mayura Loganathan, MD, Mount Sinai FHT