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Timing Prompts for Advance Care Planning Discussions and Advance Directive Completion
Neil S Wenger1, Fernando Javier Sanz Vidorreta1,2, Chi-Hong Tseng1
1Division of General Internal Medicine and Health Services Research, University of California, Los Angeles.
JAMA Network Open
|August 10, 2026
Summary
Advance care planning (ACP) interventions delivered before primary care visits increased the likelihood of patients completing advance directives or POLST forms. This appointment-based approach also led to more documented patient-clinician discussions about goals of care.
Area of Science:
- Primary Care Medicine
- Health Services Research
- Geriatrics
Background:
- Advance care planning (ACP) is crucial for aligning medical care with patient goals, especially for those with serious illnesses.
- Effective, pragmatic strategies for implementing ACP remain a challenge in clinical practice.
Purpose of the Study:
- To compare the effectiveness of an appointment-based ACP intervention versus a non-appointment-based intervention.
- To assess the association of intervention timing with ACP uptake and documentation.
Main Methods:
- Retrospective cohort study of 5810 primary care patients with serious illness lacking advance directives.
- Interventions included appointment-based ACP delivered 7-21 days before a visit and non-appointment-based ACP.
- Outcomes measured included advance directive/POLST completion and documented ACP discussions at 12 and 24 months.
Main Results:
- Appointment-based ACP interventions were associated with significantly higher rates of advance directive or POLST completion (16.7% vs 9.8%).
- Documented patient-clinician ACP discussions were also more frequent with appointment-based interventions (40.2% vs 27.5%).
- These positive associations were consistent across all tested ACP intervention groups.
Conclusions:
- An ACP intervention delivered appointment-based before a primary care visit is associated with greater uptake of advance care planning.
- This strategy enhances the completion of advance directives and facilitates documented discussions about patient goals of care.
- The findings support the integration of timely, appointment-based ACP interventions into routine primary care for patients with serious illness.
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