Barriers to Completing Advance Care Planning: Insights From the Wausau Free Clinic

Grace F. Wittenberg, MD; Lauren Woyak, MD; Jeffrey Todd, MS, CMPE; Jeffrey Oswald, MD; Amy Prunuske, PhD

WMJ. 2025;124(3):280-282.

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ABSTRACT

Background: Advance care planning (ACP) encourages individuals to express their health care wishes should they become incapacitated and to use an advance directive to designate an individual to make health care decisions on their behalf.

Methods: A survey on ACP was administered at the Wausau Free Clinic in Wausau, Wisconsin in English or Spanish to participants 18 or older from February to May 2023.

Results: Of 46 respondents, 80% had not heard of ACP. One in 10 said a physician had had a conversation with them about ACP. Health care access and lack of education were the biggest challenges to ACP.

Discussion: Most individuals who utilize the clinic were unaware of ACP. Wisconsin is not a “next of kin” state, which increases the importance of ACP completion.

Author Affiliations: Department of Regional Campuses, Medical College of Wisconsin-Central Wisconsin, Wausau, Wisconsin (Wittenberg, Woyak, Prunuske); Wausau Free Clinic, Wausau, Wisconsin (Wittenberg, Todd, Oswald).
Corresponding Author: Grace Wittenberg, email wittenberggrace@gmail.com; ORCID ID 0000-0001-9862-3107
Financial Disclosures: None declared.
Funding/Support: None declared.
Acknowledgements: The authors would like to thank Paula Vogt, RN, and Leslie Thiele for their ACP expertise and assistance with drafting the questionnaire and Francisco Guerrero, a Health Coverage Navigator and Spanish Interpreter for assisting in the creation of the survey, as well as the other Spanish interpreters who helped administer the survey at the WFC. They would also like to thank Kim Shibilski for helping with the administration of the project into clinic workflow.

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