Pragmatic Trial to Increase Advance Care Planning: Anne Walling, Neil Wenger, & Rebecca Sudore

This episode of GeriPal features a deep dive into a pragmatic, real-world cluster-randomized trial led by Anne Walling, Neil Wenger, and Rebecca Sudore to improve advanced care planning (ACP) documentation in electronic health records (EHRs) across three University of California healthcare systems. The study focused on primary care patients with serious illness, using a validated EHR-based phenotype to identify this population through structured data—avoiding reliance on prognosis-based models. The intervention included three arms: sending patients pre-visit messages about ACP, adding links to the Prepare for Your Care website, and deploying non-clinician healthcare navigators to engage patients and prepare clinicians for conversations. Results showed that all three approaches increased ACP documentation, with the navigator arm achieving 20% documentation rates compared to 13–14% in the other groups. Crucially, the study also demonstrated increased goals-of-care conversations, a key indicator of meaningful engagement. Despite low absolute rates of completion, the researchers emphasize that the real value lies in building a sustainable, scalable infrastructure that supports ongoing, patient-centered conversations and aligns care with patient values over time.