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Easy-to-Use Advance Care Planning (ACP) Tools Increase Planning among Older Veterans

August 22, 2017


The advance care planning (ACP) process involves a series of discussions over time in addition to the completion of an advance directive (AD). However, most older adults have not engaged in ACP, and patients' wishes are often not documented. Study investigators created the PREPARE website, which has been shown to empower older adults to engage in ACP through the use of a simple 5-step process and "how-to" videos. In addition, the team created an easy-to-read advance directive that has significantly increased patient documentation of ACP. The goal of this clinical trial was to compare the efficacy of PREPARE plus the easy-to-read AD (PREPARE plus AD) vs. the AD alone (AD-only) to increase ACP documentation and engagement. Veterans aged 60 years and older with at least two chronic medical conditions (n=414) were enrolled from a women's, geriatrics, and several general medicine clinics at the San Francisco VAMC from April 2013 through July 2016. Study results show:

  • PREPARE plus an easy-to-read advance directive (AD) resulted in statistically significant higher advance care planning documentation (ACP) (35%) compared with an easy-to-read AD alone (25%).
  • PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores.
  • Both tools were rated highly in terms of ease-of-use, satisfaction, helpfulness, and the likelihood Veterans would recommend the guide to others.

Patient-facing advance care planning tools increased advance care planning documentation and engagement without additional clinician- or system-level interventions. This study suggests that PREPARE may increase advance care planning with minimal healthcare system resources.

Sudore RL, Boscardin J, Feuz MA, McMahan RD, Katen MT, Barnes DE. Effect of the PREPARE Website vs. an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement among Veterans: A Randomized Clinical Trial. JAMA Internal Medicine. August 1, 2017;177(8):1102-1109.