• Terri R Fried, Andrea L Paiva, Colleen A Redding, Lynne Iannone, John R O'Leary, Maria Zenoni, Megan M Risi, Slawomir Mejnartowicz, and Joseph S Rossi.
• Yale School of Medicine, New Haven, and Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut (T.R.F.).
• Ann. Intern. Med. 2021 Nov 1; 174 (11): 1519-1527.

BackgroundInterventions with the potential for broad reach in ambulatory settings are necessary to achieve a life course approach to advance care planning.ObjectiveTo examine the effect of a computer-tailored, behavioral health model-based intervention on the engagement of adults in advance care planning recruited from ambulatory care settings.DesignCluster randomized controlled trial with participant-level analysis. (ClinicalTrials.gov: NCT03137459).Setting10 pairs of primary and selected specialty care practices matched on patient sociodemographic information.ParticipantsEnglish-speaking adults aged 55 years or older; 454 adults at practices randomly assigned to usual care and 455 at practices randomly assigned to intervention.InterventionBrief telephone or web-based assessment generating a mailed, individually tailored feedback report with a stage-matched brochure at baseline, 2 months, and 4 months.MeasurementsThe primary outcome was completion of the following 4 advance care planning activities at 6 months: identifying and communicating with a trusted person about views on quality versus quantity of life, assignment of a health care agent, completion of a living will, and ensuring that the documents are in the medical record-assessed by a blinded interviewer. Secondary outcomes were completion of individual advance care planning activities.ResultsParticipants were 64% women and 76% White. The mean age was 68.3 years (SD, 8.3). The predicted probability of completing all advance care planning activities in usual care sites was 8.2% (95% CI, 4.9% to 11.4%) versus 14.1% (CI, 11.0% to 17.2%) in intervention sites (adjusted risk difference, 5.2 percentage points [CI, 1.6 to 8.8 percentage points]). Prespecified subgroup analysis found no statistically significant interactions between the intervention and age, education, or race.LimitationsThe study was done in a single region and excluded non-English speaking participants. No information was collected about nonparticipants.ConclusionA brief, easily delivered, tailored print intervention increased participation in advance care planning in ambulatory care settings.Primary Funding SourceNational Institute of Nursing Research and National Institute of Aging.

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