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How Patient Portals Can Improve Advance Care Planning Talks

Patient portals can help bridge the disconnect between patient and provider when engaging in advance care planning discussions, thus boosting patient satisfaction.

Using a patient-centered framework to input advance care planning (ACP) preferences into a patient portal may be the key to ensuring patient satisfaction at the end of life, research shows.

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In a study published in the American Journal of Managed Care, a research team out of Ohio State University explained that too few providers engage in ACP conversations, leading to few patients having their preferences considered when they reach end of life. In order to remedy that, the team set out to determine best practices in recording ACP directives on an EHR-tethered personal health record called MyChart.

Those best practices evolved into a patient-centered framework, which was eventually tested on pilot groups of patients and providers.

A retrospective analysis of the patient pilot groups showed that the framework generally functioned well, but that patients identified four main areas for improvement.

“Patient focus group analysis revealed several common preferences present in each of the respective groups: a preference for clear language in communication tools; endorsement of MyChart as a helpful communication tool; a need to qualify and disqualify preferred decision makers; and a desire to personalize content, often based on previous experiences,” the research team reported. “These preferences were used to tailor an initial ACP framework for MyChart.”

From there, the team refined the framework to better suit patient preferences. Following those revisions, the researchers noted several more patient critiques, including difficulty to register for the ACP portal and difficulty in locating direct messaging functions in the portal.

Pilot patients also expressed that some of the questions needed re-working, that they needed more guidance in completing tasks in the patient portal, that they felt uncomfortable with some of the questions asked, and that some of the questions should include follow-up discussions.

Aside from the patient feedback that the team received, this research revealed something important to patient-centered healthcare: a better method by which they can receive and consider ACP directives.

Research shows that too few patients have their preferences considered when they reach end of life, mostly because providers find it difficult to engage in these kinds of conversations.

The researchers note that this is because providers face time barriers, lack the training required to engage in these conversations, and are sometimes uncertain of a patient’s prognosis. Providers also face issues in accessing ACP directives because they are not always easily accessible in the EHR.

This does not diminish the value of ACP conversations, however. Noting patient preferences for end-of-life care is an important part of ensuring patients’ comfort and preserving their dignity as they face the end of their lives, as well as boosts caregiver satisfaction and wellbeing following a relative’s death.

Advance care planning (ACP) clarifies personal preferences, resulting in written advance directives (ADs) for future medical decisions in the event of health decision-making incapacity.1,2 It helps patients: a) reflect on goals, values, and beliefs; b) consider future treatment preferences; c) appoint a surrogate decision maker; and d) document their wishes regarding future medical treatment. ACP is associated with improved patient satisfaction with care, improved quality of life in terminal illness, and better psychological outcomes of family members after patient death.

In developing this framework, and making it centered around health IT and patient portals, the researchers have created a better method by which patients and providers can record ACP directives.

“The use of an EHR to deliver and support the ACP process could be advantageous to both care providers and patients, offering a more efficient use of time and resources,” the researchers concluded.

“Although stand-alone tools aid in the process, these tools do not interface with medical records. Our framework allows for ACP documentation to be accessible by the individual and their medical team when it is most needed. This newly developed framework serves as a clinical tool, yet retains benefits of patient-initiated electronic ACP documentation.”

Going forward, the researchers suggested more research be done on a larger and more diverse patient population in order to better generalize patient preferences for ACP discussions via a patient portal.

Providers should also consider adopting such an approach, the team said, and implement it carefully within a primary care practice to better influence patient satisfaction.

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