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Effectiveness of Advance Care Planning Group Visits Among Older Adults in Primary Care.
J Am Geriatr Soc. 2020 Jul 29 [Online ahead of print]JA

Abstract

BACKGROUND

Group visits can support health behavior change and self-efficacy. In primary care, an advance care planning (ACP) group visit may leverage group dynamics and peer mentorship to facilitate education and personal goal setting that result in ACP engagement.

OBJECTIVE

To determine whether the ENgaging in Advance Care Planning Talks (ENACT) group visits intervention improves ACP documentation and readiness in older adults.

METHODS

This randomized clinical trial was conducted among geriatric primary care patients from the University of Colorado Hospital Seniors Clinic, Aurora, CO, from August 2017 to November 2019. Participants randomized to ENACT group visits (n = 55) participated in two 2-hour sessions with discussions of ACP topics and use of ACP tools (i.e., Conversation Starter Kit, Medical Durable Power of Attorney form, and PREPARE videos). Participants randomized to the control arm (n = 55) received the Conversation Starter Kit and a Medical Durable Power of Attorney form by mail. The primary outcomes included presence of ACP documents or medical decision-maker documentation in the electronic health record (EHR) at 6 months, and a secondary outcome was ACP readiness (validated four-item ACP Engagement Survey) at 6 months.

RESULTS

Participants were a mean of 77 years old, 60% female, and 79% white. At 6 months, 71% of ENACT participants had an advance directive in the EHR (26% higher) compared with 45% of control arm participants (P < .001). Similarly, 93% of ENACT participants had decision-maker documentation in the EHR (29% higher) compared with 73% in the control arm (P < .001). ENACT participants trended toward higher readiness to engage in ACP compared with control (4.56 vs 4.13; P = .16) at 6 months.

CONCLUSION

An ACP group visit increased ACP documentation and readiness to engage in ACP behavior change. Primary care teams can explore implementation and adaptation of ACP group visits into routine care, as well as longer-term impact on patient health outcomes.

Authors+Show Affiliations

Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA. Geriatric Research Education and Clinical Center, Eastern Colorado Health Care System, Aurora, Colorado, USA.University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA. Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA.Division of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA.Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.Division of General Internal Medicine , Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Eastern Colorado Health Care System, Aurora, Colorado, USA. Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.Division of Geriatric Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32726475

Citation

Lum, Hillary D., et al. "Effectiveness of Advance Care Planning Group Visits Among Older Adults in Primary Care." Journal of the American Geriatrics Society, 2020.
Lum HD, Dukes J, Daddato AE, et al. Effectiveness of Advance Care Planning Group Visits Among Older Adults in Primary Care. J Am Geriatr Soc. 2020.
Lum, H. D., Dukes, J., Daddato, A. E., Juarez-Colunga, E., Shanbhag, P., Kutner, J. S., Levy, C. R., & Sudore, R. L. (2020). Effectiveness of Advance Care Planning Group Visits Among Older Adults in Primary Care. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.16694
Lum HD, et al. Effectiveness of Advance Care Planning Group Visits Among Older Adults in Primary Care. J Am Geriatr Soc. 2020 Jul 29; PubMed PMID: 32726475.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of Advance Care Planning Group Visits Among Older Adults in Primary Care. AU - Lum,Hillary D, AU - Dukes,Joanna, AU - Daddato,Andrea E, AU - Juarez-Colunga,Elizabeth, AU - Shanbhag,Prajakta, AU - Kutner,Jean S, AU - Levy,Cari R, AU - Sudore,Rebecca L, Y1 - 2020/07/29/ PY - 2020/03/30/received PY - 2020/05/21/revised PY - 2020/06/07/accepted PY - 2020/7/30/entrez PY - 2020/7/30/pubmed PY - 2020/7/30/medline KW - advance care planning KW - advance directives KW - behavior change KW - group medical visits KW - primary care JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc N2 - BACKGROUND: Group visits can support health behavior change and self-efficacy. In primary care, an advance care planning (ACP) group visit may leverage group dynamics and peer mentorship to facilitate education and personal goal setting that result in ACP engagement. OBJECTIVE: To determine whether the ENgaging in Advance Care Planning Talks (ENACT) group visits intervention improves ACP documentation and readiness in older adults. METHODS: This randomized clinical trial was conducted among geriatric primary care patients from the University of Colorado Hospital Seniors Clinic, Aurora, CO, from August 2017 to November 2019. Participants randomized to ENACT group visits (n = 55) participated in two 2-hour sessions with discussions of ACP topics and use of ACP tools (i.e., Conversation Starter Kit, Medical Durable Power of Attorney form, and PREPARE videos). Participants randomized to the control arm (n = 55) received the Conversation Starter Kit and a Medical Durable Power of Attorney form by mail. The primary outcomes included presence of ACP documents or medical decision-maker documentation in the electronic health record (EHR) at 6 months, and a secondary outcome was ACP readiness (validated four-item ACP Engagement Survey) at 6 months. RESULTS: Participants were a mean of 77 years old, 60% female, and 79% white. At 6 months, 71% of ENACT participants had an advance directive in the EHR (26% higher) compared with 45% of control arm participants (P < .001). Similarly, 93% of ENACT participants had decision-maker documentation in the EHR (29% higher) compared with 73% in the control arm (P < .001). ENACT participants trended toward higher readiness to engage in ACP compared with control (4.56 vs 4.13; P = .16) at 6 months. CONCLUSION: An ACP group visit increased ACP documentation and readiness to engage in ACP behavior change. Primary care teams can explore implementation and adaptation of ACP group visits into routine care, as well as longer-term impact on patient health outcomes. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/32726475/Effectiveness_of_Advance_Care_Planning_Group_Visits_Among_Older_Adults_in_Primary_Care_ L2 - https://doi.org/10.1111/jgs.16694 DB - PRIME DP - Unbound Medicine ER -
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