A groundbreaking strategy for advance care planning (ACP) that incorporates automated outreach has significantly increased the number of patients completing documentation to outline their wishes during serious illness, according to new research. The study, conducted across several University of California health systems, highlights the potential for technology-driven interventions to facilitate crucial healthcare conversations.
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 acknowledged the challenges faced by primary care doctors who often have limited time due to other clinical concerns.
Understanding the Research and Its Implications
The research, published in the Annals of Internal Medicine, sought to identify the most effective methods for encouraging patients to complete advance care plans. It compared three different ACP interventions at healthcare clinics within UCLA, the University of California, San Francisco, and the University of California, Irvine. The study involved approximately 8,000 seriously ill patients who had regular interactions with their primary care physicians.
The primary outcome measured was the completion of an advance directive at 12 and 24 months. The interventions varied in their approach, with one involving electronic health record portal messages, another adding resources from PrepareForYourCare.org, and a third incorporating health navigator outreach for additional assistance.
Results and Expert Insights
The findings revealed that 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 records. This suggests that automated outreach, particularly with the involvement of health navigators, effectively prompts ACP discussions.
“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 stated.
Dr. Anne Walling, the study’s first author, noted, “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.”
Broader Context and Future Directions
The study’s results, while promising, are specific to the University of California health systems and may not be directly applicable to other healthcare settings. The researchers noted the absence of a control group as a limitation, although the patient sample was diverse.
Looking forward, Dr. Walling suggested expanding the intervention to a broader patient group and other healthcare systems. “The advance care planning intervention can be a foundation on which to build more sophisticated conversations and decision making,” she said.
Co-authors of the study include Dr. Rebecca Sudore, Dr. Lisa Gibbs, Dr. Maryam Rahimi, and several others from UCLA, UCSF, and UCI. The research was funded by a Patient-Centered Outcomes Research Institute (PCORI) award.
Implications for Healthcare Systems
This development follows increasing recognition of the need for structured ACP discussions in healthcare. By integrating automated outreach and health navigator support, healthcare systems can better align patient care with individual goals and preferences. This approach not only enhances patient autonomy but also ensures that medical care is more closely tailored to patient needs during critical times.
As healthcare systems continue to evolve, the integration of technology with traditional care practices offers a pathway to more effective and patient-centered care. The study’s insights provide a valuable framework for other institutions seeking to improve their ACP processes and patient engagement.
