Association of Missouri Nurse Practitioners

AMNP Member requesting assistance with DNP Project

Posted 6 months ago by Aleisha Breen

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AMNP member Megan Gibbons, FNP is asking for your assistance with her DNP project pertaining to advanced directives in Missouri. Please visit the site below to complete the survey:

Information about the Project


The purpose of this project is to determine if an evidence based advanced directive intervention increases legal documentation and completion rates in healthy adults in the Missouri Community. 

As a whole, Americans are living longer and healthcare costs increase with age. Investigation of Medicare data conducted by the Kaiser Family Foundation found that Medicare spending rises with age and peaks at age 96. Out of pocket cost for patients at age 96 is $16,145, and this figure is more than double the per capita spending at age 70 ($7,566) (Morrison, 2015). Care in the last year of life has been estimated to be approximately $71,517 (Teno & Gozalo, 2014). It has been suggested that utilization of hospice drastically reduces healthcare costs and could offer a savings of $9,000 per patient (Teno & Gonzalo, 2014). Advanced directives can increase prevalence of patients choosing less invasive and intense treatments in the end of life. Education can better facilitate patients’ understanding hospice and end of life care, ensuring more informed decisions regarding care they desire to receive. Missouri State Department of Health and Senior Services does not currently track the completion of advanced directives; this project could help to establish importance of tracking this data.



The evidence based intervention to be used for this community program will involve comprehensive education and counseling regarding advanced directives, including end of life care, benefits of advance care planning, and about the advanced directive documentation specifically. 



Participants will be enrolled upon access of the webpage they were directed to. The online website will inform them about the project and given details of the requirements for participation prior to initiation of intervention. 



It will be encouraged for participants to include their family or friends during the online interaction. 

The intervention will take place in an online format via an interactive website accessed by participants from home or other convenient location. Upon enrollment in the intervention, participants will be informed about project and complete baseline data. Baseline data will include demographic data (age,ethnicity, education, marital status, and religious preference), current advanced directive status, an advance directive engagement survey, and contact email address . The intervention will implement and include materials from the PREPARE for your Care program. This is a step-by-step video platform to support participants having a voice in their medical care, talking with providers, and facilitating questions being answered about their medical wishes. Upon completion of educational content then the participant will access Missouri State Advanced directive paperwork. The participant will be instructed on the steps to complete the form and how to have it legally notarized. Follow up will occur three months after the intervention with an email link to survey to determine if the paperwork had been completed and legally notarized. 


Demographic data is being collected because research has shown that these are variables that may affect advanced directive decision making and will be reported in aggregate. 


The primary outcome will be measured by self-report of legal completion of Missouri state advanced directive paperwork. Permission for use of the advanced directive engagement survey instrument has been obtained from the PREPARE for Your Care team. The 34-item version of the survey has Behavior Change Process measures and take approximately 10-15 minutes to complete. This survey uses a 5-point Likert response. The Behavior Change Process score is reported as an overall 5-point Likert score. The Behavior Change Process measure has validated sub-scales of knowledge, self-efficacy, and readiness reported individually as average 5-point Likert scales.


Megan Gibbons MSN, RN, FNP-BC, NP-C

Family Nurse Practitioner



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