Rebecca L. Sudore|Dean Schillinger|Mary Katen|Ying Shi|W. John Boscardin|Stacy Osua|Deborah E. Barnes
Engaging Diverse English- and Spanish-Speaking Older Adults in Advance Care Planning
San Francisco General Hospital|University of California, San Francisco|San Francisco VA Health Care System|Northern California Institute for Research and Education|San Francisco General Hospital|University of California, San Francisco|University of California, San Francisco|San Francisco VA Health Care System|Northern California Institute for Research and Education|University of California, San Francisco|San Francisco VA Health Care System|University of California, San Francisco|University of California, San Francisco|San Francisco VA Health Care System|Northern California Institute for Research and Education|San Francisco General Hospital|San Francisco VA Health Care System|University of California, San Francisco
advance care planning improves receipt medical care aligned patients values however remains suboptimal among diverse patient populations mitigate literacy cultural language barriers advance care planning easytoread advance directives patientdirected online advance care planning program called prepare care prepare created english spanishto compare efficacy prepare plus easytoread advance directive advance directive alone increase advance care planning documentation patientreported engagementa comparative efficacy randomized clinical trial conducted february 1 2014 november 30 2017 4 safetynet primarycare clinics san francisco among 986 englishspeaking spanishspeaking primary care patients 55 years older 2 chronic serious illnessesparticipants randomized prepare plus easytoread advance directive prepare arm advance directive alone clinicianlevel systemlevel interventions staff blinded followup measurementsthe primary outcome documentation new advance care planning ie legal forms andor documented discussions 15 months patientreported outcomes included advance care planning engagement baseline 1 week 3 months 6 months 12 months using validated surveys intentiontotreat analyses performed using mixedeffects logistic linear regression controlling time health literacy baseline advance care planning clustering physician stratifying languageamong 986 participants 603 women 383 men mean sd age 633 64 years 387 975 397 limited health literacy 445 451 spanish speaking participant characteristic differed 2 groups retention 859 832 969 among survivors compared advance directive alone prepare resulted higher rate advance care planning documentation unadjusted 430 207 481 vs 331 167 505 p 001 adjusted 430 vs 320 p 001 higher selfreported increased advance care planning engagement scores 981 vs 895 p 001 results remained significant among english speakers spanish speakersthe patientfacing prepare program easytoread advance directive without clinicianlevel systemlevel interventions increased documentation advance care planning patientreported engagement statistically higher gains prepare vs advance directive alone tools may mitigate literacy language barriers advance care planning allow patients begin planning could substantially improve process diverse englishspeaking spanishspeaking populationsclinicaltrialsgov identifiers nct01990235 nct02072941