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Advance care planning trainees may offer a feasible way for primary care clinics to increase documentation of patients’ end-of-life wishes, according to a new study examining a quality improvement intervention in a geriatric primary care clinic. “Using existing structures, such as medical trainees who are motivated to learn and participate, may be a feasible way for primary care clinics to increase ACP,” the study authors wrote.
How the Advance Care Planning Trainees Study Was Conducted
Researchers conducted a retrospective analysis of a quality improvement intervention in a geriatric primary care clinic in New Jersey to evaluate the effectiveness of a medical trainee-led ACP intervention. A total of 498 patients older than 60 years with no advance directives or POLST documented in their electronic medical records were included in the study of advance care planning trainees and their impact on documentation rates.
Comparing Trainee-Led Sessions to Standard Care
Of those patients, 65 received a trainee-led ACP education session, with a median age of 80 years and 68% women, from March to April 2023. The remaining 433 patients received standard care, with a median age of 81 years and 73% women, providing a comparison group against which the effects of advance care planning trainees could be measured.
Why Advance Care Planning Trainees May Help Close a Gap
Advance care planning documentation has long lagged in primary care settings, particularly among older adults who may benefit most from having their wishes clearly recorded. By leveraging advance care planning trainees already embedded in clinic workflows, the intervention offers a potentially low-cost way to address this gap without requiring additional staff hires or major workflow overhauls.
Who Led the Research
The study was led by Zehra B. Omer, MD, of the Division of Geriatrics at Hackensack University Medical Center in Hackensack, New Jersey. It was published online on June 30, 2026, in the Journal of General Internal Medicine, adding to a growing body of literature examining how advance care planning trainees and similar workforce-based interventions can improve ACP rates.
Limitations of the Advance Care Planning Trainees Study
The study was conducted at a single primary care clinic serving a population of adults older than 60 years, which might not apply to other primary care settings. The intervention also relied on having motivated medical trainees involved in the clinic workflow, a condition that may not exist in all community settings where advance care planning trainees might otherwise be deployed.
A Small Sample Size
The sample size in the trainee-led intervention group was small, at just 65 patients, a limitation the authors acknowledge could affect how confidently the findings generalize to larger or more diverse patient populations. Hackensack Meridian Health resources provided support for this study, and the authors reported no relevant conflicts of interest.
What This Means for Primary Care Clinics
Given the modest cost and existing infrastructure involved, advance care planning trainees could represent an accessible option for clinics looking to boost ACP documentation without significant new investment. As more research explores this approach across different settings and patient populations, clinics may gain clearer guidance on how to structure trainee-led ACP interventions effectively going forward.
How This Fits Into Broader ACP Research
The findings on advance care planning trainees join a growing body of research testing different workforce-based approaches to boosting ACP documentation, including nurse navigator-led pathways and interprofessional training models involving social work interns. Compared to some of these other interventions, which have shown documentation increases ranging from roughly 20% to over 40% depending on the model and patient population, a trainee-led approach may offer a comparatively simpler implementation path since it relies on staff already present in academic-affiliated clinics rather than requiring new hires or specialized nurse navigators. Future studies comparing the relative cost-effectiveness and scalability of these different models could help clinics decide which approach best fits their existing staffing and patient population.
