FutureCare Directions: Empowering Patient Choices at Anderson Free Clinic

Bridging the Gap: Bringing Advanced Care Planning to Underserved Patients

Megan McDonald, MD

Fellow, Medical University of South Carolina, 2025

Waco Family Medicine

At Anderson Free Clinic (AFC), a free and charitable clinic serving medically underserved patients in South Carolina, conversations about advanced care planning (ACP) have historically been limited by systemic and resource-related barriers. Many patients seen at AFC are ineligible for Medicare Annual Wellness Visits—one of the few times in which ACP is routinely addressed in traditional healthcare settings. Given the high burden of chronic illness in this population, the absence of such discussions leaves many patients vulnerable to receiving care that may not align with their values, preferences, or goals.

To address this gap, our team launched FutureCare Directions with the goal of integrating meaningful, patient-centered ACP discussions into routine clinical care at AFC. Supported by the Aequitas Health Equity Honor Society Fellow Project Grant, the initiative focused on developing a comprehensive yet accessible ACP handout designed specifically for our patient population. The handout aimed to demystify advanced care directives, address common misconceptions, and empower patients to engage in decisions about their future healthcare. Recognizing the pivotal role medical students play at AFC, the project also prioritized training students and volunteer providers to initiate these sensitive conversations in a respectful and culturally competent manner.

The grant funding was used to support the design and printing of the handouts in both English and Spanish, the development of teaching materials and modules to aid in training staff, and the development of templates to standardize documentation of ACP conversations in the clinic’s electronic medical record. A portion of the funds was also allocated toward small incentives to encourage engagement from volunteers and reinforce the value of this work within the clinic community.

Since the launch of the project, 12 medical students and clinic staff helped contribute to the project and engage in conversations with their patients about ACP. Feedback reflects increased comfort and willingness to initiate these important conversations and ease at which students and staff can integrate these conversations into daily clinic visits. Qualitative feedback has shown that both patients and providers feel more confident engaging in these conversations. Patients report greater clarity and peace of mind, while students describe a deeper understanding of the ethical dimensions of care and a growing sense of responsibility in advocating for their patients’ wishes.

Plans are in place to continue the project’s impact this year by developing and implementing a specific ACP training module into the clinic’s onboarding process for all new student volunteers. We are also hoping to engage a broader range of providers at AFC, including volunteer attending physicians who may come see patients at the clinic one to two days weekly or monthly.

We are also exploring opportunities to collaborate with local palliative care providers and ethicists to offer periodic educational talks to for staff and patients. Data collection is ongoing with the goal to collect long-term outcome data to further evaluate the impact on hospitalizations, patient satisfaction, and end-of-life care alignment.