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Symposium

Social Research, Policy, and Practice

Pragmatic Implementation of an Advance Care Planning Intervention: Findings from SHARING Choices

Saturday, November 11, 2023
12:00 PM – 1:30 PM ET
Location: Room 112

Advance care planning (ACP) is defined as a key task in ambulatory care for patients to share values, goals, and preferences for future medical care. Ideally ACP is revisited throughout the course of serious illness and engages family in discussions with clinicians. Most interventions, however, have not targeted primary care as a setting for ACP but have instead targeted a specific illness, conversation or setting such as the inpatient hospital or nursing home. Additionally, family is often not included in ACP discussions. This symposium will discuss critical components of the SHARING Choices cluster-randomized pragmatic trial, including the setup, monitoring, and analysis of this intervention within two primary care health systems located in the Baltimore-Washington DC metropolitan corridor. Each presenter will discuss key efforts conducted during the trial that highlight challenges, lessons learned, and novel approaches of embedding an evidence-based intervention within usual care settings targeting older adults 65 years of age and older. Preliminary analyses indicate that the ACP intervention was highly effective for increasing the likelihood of having advance directives in the patients’ electronic health records within 1-year of intervention initiation (odds ratio = 2.88, p < 0.001). Attendees of this symposium will take away relevant insights for implementing effective ACP and communication interventions within primary care settings as well as supporting outcome data. Our discussant will provide thoughts on the implications of these results for current primary care organizations and in the field of ACP and communication for older adults including those with dementia.

Learning Objectives:

  • After attending this session, participants will understand unique strategies for implementing a multi-component advance care planning intervention within routine primary care clinics including adaptation, fidelity monitoring, and lessons learned.
  • After attending this session, participants will understand the impact and effectiveness of the SHARING Choices intervention on select clinical and process outcomes and to discuss the barriers and enables of change experienced by stakeholders across two distributed health systems.

Presentations:

  • 12:00 PM – 1:30 PM ET
    Preliminary Findings of the Sharing Choices Intervention on Primary Outcome Measures

    Individual Symposium Abstract First Author: Jennifer Wolff, PhD (she/her/hers) – Johns Hopkins University

  • 12:00 PM – 1:30 PM ET
    Using Simulation to Assess the Fidelity of Advance Care Planning in the Context of a Pragmatic Trial

    Individual Symposium Abstract First Author: Valerie T. Cotter, DrNP, FAANP, FAAN – Johns Hopkins University

  • 12:00 PM – 1:30 PM ET
    Pragmatic Implementation of an Advance Care Planning Initiative: Moving Knowledge Into Action

    Individual Symposium Abstract First Author: Kelly M. Smith, PhD (she/her/hers) – University of Toronto

  • 12:00 PM – 1:30 PM ET
    Multilevel Perceptions of Implementing SHARING CHOICES: A Qualitative Study

    Individual Symposium Abstract First Author: Martha Abshire Saylor, PhD, RN (she/her/hers) – Johns Hopkins University School of Nursing