Rebecca L. Sudore|John Boscardin|Mariko Feuz|Ryan Mcmahan|Mary Katen|Deborah E. Barnes
Effect of the PREPARE Website vs an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement Among Veterans
San Francisco VA Medical Center|University of California, San Francisco|University of California, San Francisco|San Francisco VA Medical Center|University of California, San Francisco|San Francisco VA Medical Center|University of California, San Francisco|San Francisco VA Medical Center|University of California, San Francisco|San Francisco VA Medical Center|University of California, San Francisco
documentation rates patients medical wishes often low unknown whether easytouse patientfacing advance care planning acp interventions overcome barriers planning busy primary care settingsto compare efficacy interactive patientcentered acp website prepare easytoread advance directive ad increase planning documentationthis comparative effectiveness randomized clinical trial april 2013 july 2016 conducted multiple primary care clinics san francisco va medical center inclusion criteria age least 60 years least 2 chronic andor serious conditions 2 primary care visits 2 additional clinic hospital emergency room visits last yearparticipants randomized review prepare plus easytoread ad ad alone clinician andor systemlevel interventions education research staff blinded followup measurementsthe primary outcome new acp documentation ie legal forms andor discussions 9 months secondary outcomes included patientreported acp engagement 1 week 3 months 6 months using validated surveys behavior change process measures ie 5point knowledge selfefficacy readiness scales action measures eg surrogate designation using 025 scale used intentiontotreat mixedeffects logistic linear regression controlling time health literacy raceethnicity baseline acp clustering physicianthe mean sd age 414 participants 71 8 years 38 9 women 83 20 limited literacy 179 43 nonwhite participant characteristic differed significantly among study arms baseline retention 6 months 90 advance care planning documentation 6 months enrollment higher prepare arm vs adalone arm adjusted 35 vs 25 odds ratio 161 95 ci 103251 p 04 prepare also resulted higher selfreported acp engagement followup including higher process action scores p 001 followupeasytouse patientfacing acp tools without clinician andor systemlevel interventions increase planning documentation 25 35 combining prepare website easytoread ad resulted higher planning documentation ad alone suggesting prepare may increase planning documentation minimal health care system resourcesclinicaltrialsgov identifier nct01550731