Rebecca L. Sudore|Mary Katen|Ying Shi|John Boscardin|Stacy Osua|Deborah E. Barnes
Engaging Diverse English- and Spanish-Speaking Older Adults in Advance Care Planning: The PREPARE Randomized Clinical Trial (FR421D)
University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco
describe design implementation free easytouse patient facing advance care planning tools wwwprepareforyourcareorg particularly vulnerable disenfranchised populationsdescribe comparative efficacy online advance care planning program called prepare wwwprepareforyourcareorg plus easytoread 5thgrade reading level advance directive versus advance directive alone new advance care planning documentation selfreported advance care planning engagement without additional clinician systemlevel interventions advance care planning acp improves valuealigned care yet remains suboptimal among diverse patient populations mitigate literacy cultural language barriers created easytoread advance directives ads patientdirected online acp program called prepare english spanish compare efficacy prepare plus easytoread ad prepare arm ad alone increase acp documentation patientreported engagement conducted comparative efficacy randomized trial february 2014 november 2017 four san francisco safetynet primarycare clinics among english spanishspeaking adults age 55 years 2 chronic serious illnesses participants randomized prepare arm ad alone cliniciansystemlevel interventions staff blinded followup assessments primary outcome new acp ie legal forms andor documented discussions 15 months patientreported outcomes included acp engagement baseline 1 week 3 6 12 months using validated surveys used intentiontotreat mixedeffects logistic linear regression controlling time health literacy baseline acp clustering physician stratifying language mean sd age 986 participants 633 years 64 397 limited health literacy 45 spanishspeaking participant characteristic differed arms retention 859 compared ad alone prepare resulted higher acp documentation adjusted 43 vs 32 p0001 higher selfreported increased acp engagement 981 vs 895 p0001 results remained significant among english spanish speakers patientfacing prepare program easytoread ad without cliniciansystemlevel interventions increased acp documentation patientreported engagement statistically higher gains prepare english spanishspeaking older adults