Evaluating Diverse Methodologies and Interventions for Facilitating Advance Care Planning (ACP) Among Seriously Ill Patients: Lessons from Ongoing PCORI-funded ACP Trials (FR415)

Abstract

•Describe diverse methodologies for implementing interventions to increase advance care planning for seriously ill patients in three PCORI-funded large, multi-site comparative effectiveness trials.•Describe real-world challenges of implementing and evaluating advance care planning interventions for seriously ill patients.•Engage in an interactive activity to identify barriers and solutions to implementing advance care planning in a variety of real-world clinical settings. PCORI recently funded three large, multi-site trials focused on advance care planning (ACP) among seriously ill patients. Each trial takes a unique methodologic approach including different ACP interventions, implementation strategies, and methods for measuring program success. Collectively these trials answer critical questions related to delivery of ACP in real-world settings including identifying the optimal mix of clinicians needed to engage in ACP, evaluating approaches for reducing disparities in ACP and associated outcomes, and understanding the intensity of ACP interventions needed to facilitate optimal patient and caregiver outcomes.•One study is evaluating two different implementation strategies for the Serious Illness Care Program (SICP): primary care clinician-focused versus multidisciplinary team focused, and will enroll over 1,000 patients from 42 primary care clinics in the U.S. and Canada.•A second study is comparing the effectiveness of two ACP interventions (Respecting Choices vs. Five Wishes) in reducing racial disparities in ACP and patient outcomes among 800 seriously ill older adults from 10 clinics in Southern U.S.•A third population-based study is comparing the effectiveness on multi-level outcomes of three ACP interventions that vary in intensity (advance directive alone; advance directive plus the Prepare For Your Care decision support website; advance directive plus PREPARE plus ACP health care navigator facilitation. This study will enroll 6,000 patients with serious illness from 50 primary care clinics in California. In this session, we will review and contrast the variety of ACP models and tools, including supporting evidence, being tested in these studies. We will also explore the different approaches to population selection, ACP implementation and evaluation, and stakeholder engagement taken in these studies. Participants will then be engaged in an interactive exercise to consider how the experience to date in these three trials could inform the implementation of ACP for their own clinics and health systems.