A new strategy involving automated outreach has significantly increased the number of seriously ill patients completing advance care planning (ACP) documentation, according to recent research. The study, conducted across several University of California health systems, found that when staff reached out to patients to offer assistance, more patients completed documentation outlining their medical care wishes in times of serious illness.
Dr. Neil Wenger, a professor of medicine at the David Geffen School of Medicine at UCLA and the study’s senior author, emphasized the importance of these discussions. “People with serious illnesses should discuss their medical care wishes with families and doctors,” he said. However, he noted that these conversations can be challenging, especially for primary care physicians who are often pressed for time due to other clinical responsibilities.
Exploring Effective Interventions
The research, published in the Annals of Internal Medicine, compared three different ACP interventions across healthcare clinics at UCLA, UC San Francisco, and UC Irvine. Approximately 8,000 seriously ill patients, all of whom had a primary care physician within one of these university health systems, participated in the study. These patients had seen their doctor at least twice in the previous year. The study’s main focus was whether these interventions led to the completion of an advance directive at 12 and 24 months.
Dr. Anne Walling, the study’s first author, highlighted the significance of structured approaches to stimulate advance care planning. “Nearly everyone will become seriously ill at some time, and creating better structures to stimulate advance care planning means that people will be more likely to have earlier conversations leading to medical care aligned with goals,” she explained.
Details of the Interventions
The first intervention involved sending patients a message through their electronic health record portal, which included a link to an advance directive and a mailed message outlining its importance and steps for completion. The second intervention added a link to PrepareForYourCare.org, a resource for informed medical decision-making and advance directive guidance. The third intervention combined the previous two with additional health navigator outreach for personalized assistance. All participating physicians received ACP training.
After 24 months, 13.7% of patients in the first group, 12.7% in the second, and 19.8% in the third had completed an advance directive available in their electronic health record.
The study found that the inclusion of health navigator outreach was particularly effective, prompting more advanced care discussions than the other two interventions alone. “Health systems can put into place an automated mechanism to promote advance care planning conversations between patients and doctors within the existent clinical workflow,” Dr. Wenger noted. He added that health navigators could further enhance these conversations by contacting patients before their doctor visits.
Implications and Future Directions
While the study was limited to three University of California health systems, the researchers believe the findings could have broader implications. They acknowledge that the results may not be directly applicable to other systems, and the trial did not include a control group. Despite these limitations, the patient sample was diverse, providing valuable insights into the effectiveness of automated outreach in ACP.
Dr. Walling outlined the next steps, which include implementing the intervention with a broader patient group and extending it to other healthcare systems. “The advance care planning intervention can be a foundation on which to build more sophisticated conversations and decision making,” she said.
Study Contributors and Funding
The study’s co-authors, all affiliated with UCLA, UCSF, and UCI, include Dr. Rebecca Sudore, Dr. Lisa Gibbs, Dr. Maryam Rahimi, Ron Hays, Chi-hong Tseng, Kanan Patel, Katherine Santos, Fernando Javier Sanz Vidorreta, Aaron Chau, Juan Carlos Antonio Lopez, Jamie Anand, G. Rick Marshall, Anna DePaolis-Dickey, Kirsten Buen, Dr. Douglas Bell, Dr. Christine Ritchie, and Victor Gonzalez. The research was funded through a Patient-Centered Outcomes Research Institute (PCORI) award (PLC-1609-36291).
This development in advance care planning highlights the potential for automated outreach to improve patient engagement and ensure medical care aligns with patients’ wishes, marking a significant step forward in patient-centered healthcare.
