Clinical Perspectives from the Veterans Health Administration: The Impact of Advance Care Planning Via Group Visits on Veterans, Caregivers, and Those They Trust

Background and purpose. In the Veterans Health Administration (VHA), Advance Care Planning (ACP) via Group Visits (ACP-GV) strategically engages veterans and those they trust with the value-based propositions and action steps that lead to enhanced planning and documentation of their care preferences. As a national program, ACP-GV offers a structured, 60-minute, facilitated conversation amongst participants related to future care planning. ACP-GV also encourages participants to document a “next step,” a care planning goal to complete after the conclusion of the group. This presentation will describe the impact of ACP-GV on veterans and those they trust from the perspective of clinicians who deliver the innovative program.

Methods. Interviews for a Quality Enhancement Research Initiative (QUERI) funded partnered national program evaluation of ACP-GV were conducted with 14 sites involved in the National ACP-GV Program. A subset of the interview questions focused on the impact of the program were analyzed. Interviews were conducted in fiscal year 2021 (November - July 2021) with VHA clinical employees who were purposively selected due to their status as the point of contact or lead for a local site’s ACP-GV program at a VHA facility.

Results. Interviewees were asked if ACP-GV met the needs of veterans who have participated in ACP-GV, with over half reporting “yes” and none indicating that ACP-GV was not meeting the needs of veterans at their site. Clinicians further noted the impacts of ACP-GV on veterans in their area. Nearly half reported that awareness of ACP and Advance Directives (AD) was the most important aspect in discussing what matters most with veterans. Other impacts included the outcome, goals, and next steps that the ACP-GV program influenced, such as the completion of an AD, the ACP discussion, and the follow-up call being a good reminder of the planned next steps and to prompt having the conversation with trusted others or providers. The last category, referrals, was endorsed by a minority, and described as one veteran recommending another friend, “Battle Buddy”, or other veteran to attend a group. ACP-GV clinicians identified some groups of veterans or settings where ACP-GV was less successful in meeting the needs of veterans. Of these, the categories included veterans who live in rural areas and experience logistical issues, older veterans, veterans with technology barriers, veterans who are currently homeless, or veterans experiencing mental health issues.

Recommendations to other clinicians offering ACP-GV to veterans and those they trust include improving familiarity with ACP and ADs, the powerful influence of the next step, and recommendations to attend ACP-GV by group participants to other veterans.

Conclusions and implications. As an innovative, national program, ACP-GV engages veterans, caregivers, and those they trust with care planning knowledge that aligns with their values and action steps that lead to enhanced planning and documentation of their future care preferences should they ever become incapacitated.