Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Rebecca Davis

Second Advisor

Amy Manderscheid

Third Advisor

Iris Boettcher


In 1991 the United States Congress enacted the Patient Self-Determination Act which was an attempt by the government to improve completion rates of advance directives. Despite enactment of this law, completion rates of advance directives have remained relatively unchanged with only 18-36% of adult Americans having completed a document (United States Department of Health and Human Services, 2008). Nearly 90% of healthcare spending in the United States is on the management of chronic conditions (Centers for Disease Control and Prevention, 2015). As the baby boomer generation, which already has a high number of chronic conditions, ages our struggling healthcare system will be further strained. One important aspect of chronic disease management is advance care planning (Prystowsky, 2015). While various advance care planning programs exist, the Respecting Choices© program has been recommended by the Institute of Medicine (2015) as a viable framework to increase advance care planning activities and advance directive completion rates. A not-for-profit health care system located in West Michigan that is comprised of 12 hospitals, nearly 200 ambulatory care sites and network of more than 3,000 physicians, will soon begin implementing the Respecting Choices© advance care planning program. The proposed doctoral project includes development of a toolkit to evaluate the efficacy of the Respecting Choices© system of advance care planning at increasing advance directive completion rates and documentation of the advance directive in the medical record.

Included in

Nursing Commons