Date of Award
Fall 12-2025
Document Type
Dissertation
Publication Status
Version of Record
Submission Date
December 2025
College Granting Degree
Christine E Lynn College of Nursing
Degree Name
Doctor of Nursing Practice (DNP)
Thesis/Dissertation Advisor [Chair]
Debra J. Hain
Abstract
This quality improvement project aimed to increase early education, initiation, documentation, and completion rates of advance directives (ADs), specifically the Five Wishes, among college-aged young adults (18–24 years old) in a concierge primary care setting. The project addressed the low engagement and completion rates of ADs in this population, which can result in inadequate end-of-life care planning. The initiative involved training all staff members through collaborative instruction, informational sessions, and personalized provider-patient discussions. A convenience sample of eligible patients was identified via chart review. Inclusion criteria included English-speaking young adults aged 18–24, regardless of comorbid conditions who were members of the practice.
Statistical analysis included descriptive methods using tables, charts, and graphs to visualize trends. Pre- and post-surveys using a six-question Likert scale assessed provider knowledge, comfort, and confidence. Aggregate mean values were compared to evaluate changes, and each question was analyzed individually. A dependent sample t-test was used to determine statistically significant differences between pre- and post-intervention scores. Additionally, Wilcoxon signed-rank tests were applied to assess non-parametric data, reporting test statistics, p-values, and normality p-values.
Implications for practice include improved provider communication strategies tailored to young adults, increased AD documentation rates, and enhanced trust in patient-provider relationships. The project supports a culture of proactive healthcare planning, empowering young adults to make informed decisions. It also equips providers with tools and training to initiate meaningful conversations, fostering continuity and personalization in care.
Recommended Citation
Giovanetti, Dina M., "FROM AWARENESS TO ACTION: IMPROVING ADVANCED DIRECTIVES WITH THE FIVE WISHES IN COLLEGE AGED YOUNG ADULTS" (2025). Electronic Theses and Dissertations. 159.
https://digitalcommons.fau.edu/etd_general/159