A novel decision aid to help plan for serious illness: a multisite randomized trial

Area of Science:

• Medical Ethics
• Health Services Research
• Decision Science

Background:

• Serious illness communication and decision-making quality are often deficient.
• Advance care planning is crucial for aligning patient preferences with medical care.
• Primary care settings require effective tools to support these complex conversations.

Purpose of the Study:

• To evaluate the Plan Well Guide's efficacy in improving advance medical care planning completion.
• To assess the intervention's impact on decisional outcomes in primary care.
• To determine if the intervention enhances communication and decision-making quality for high-risk patients.

Main Methods:

• A randomized trial was conducted in 3 primary care practices.
• High-risk patients needing Goals of Care Designation (GCD) were recruited.
• Patients received either the Plan Well Guide intervention or usual care, with outcomes assessed 8-12 weeks later.

Main Results:

• GCD completion rates were similar between groups (95.3% vs. 90.9%).
• The intervention group showed improved concordance between medical orders and preferences (78% vs. 66%) and lower decisional conflict scores.
• Fewer patients in the intervention group had written orders for intensive care or CPR (34% vs. 60%).

Conclusions:

• The Plan Well Guide did not significantly increase GCD completion rates.
• The intervention improved aspects of decisional quality and reduced physician time for GCD discussions.
• Further research may explore optimizing decision support tools for advance care planning.