Date of Graduation


Document Type


Degree Name

Doctor of Nursing Practice (DNP)


DNP Completion

First Advisor

Dr. Robin Buccheri

Second Advisor

Dr. Timothy Godfrey


Problem: Research indicates a low-income status and ethnic and racial diversity is a barrier to ACP engagement.

Context: This project took place at a Federally Qualified Heath Center located in Northern California which serves approximately 200,000 diverse and economically disadvantaged patients.

Methods: The primary intervention was dissemination of an email to patients 50 and older, via their health system email account. The email included a direct link to PREPARE, an online advance care planning technology tool. A secondary intervention was a presentation to primary care providers that focused on end-of-life-care planning tools and communication strategies.

Results: The email was distributed to 22,296 patients and received a total of 895 clicks on the link to PREPARE. Pre- and post-email data did not show a significant change in ACP engagement. The provider presentation pre-and post-survey results revealed an increase in mean scores for comfort with ACP discussions, best practices for ACP discussion, and communication resources.

Conclusions: Engaging patients in ACP is a persistent challenge for primary care providers working with diverse groups within healthcare systems. As the U.S. geriatric population becomes larger and more diverse, advance health care planning needs to be prioritized in a culturally sensitive manner.