The following is a summary of “SHARING Choices: Lessons Learned from a Primary-Care Focused Advance Care Planning Intervention,” published in the August 2023 issue of Pain and Symptom Management by Colburn et al.

There have been limited instances of scaling advanced care planning (ACP) interventions within primary care settings. There is currently a lack of established protocols for implementing Advance Care Planning (ACP) on a large scale within primary care settings, and previous initiatives have not adequately included older individuals with Alzheimer’s Disease and Related dementia (ADRD). SHARING Choices (NCT#04819191) is a multicomponent cluster-randomized pragmatic trial conducted at 55 primary care practices within two care delivery systems in the Mid-Atlantic region of the United States. Researchers delineate the procedure of implementing SHARING Choices within 19 medical practices that were randomly assigned to the intervention group. 

Researchers summarize adherence to the planned implementation and discuss the insights gained from this process. Embedding COLLABORATING Choices entailed involvement with organizational and clinic-level partners in the medical context. Of 23,220 potential patients, ACP facilitators made 17,931 outreach attempts using telephone calls (77.9%) and the patient portal (22.1%). During these outreach attempts, a total of 1,215 conversations took place. Most discussions (94.8%) lasted less than 45 minutes. Only 13.1% of advance care planning (ACP) discussions involved the participation of family members. 

Patients with Alzheimer’s disease and related dementias (ADRD) constituted a minority of patients who participated in advance care planning (ACP). The implementation adaptations encompassed utilizing remote modalities, synchronizing ACP outreach with the Medicare Annual Wellness Visit, and accommodating flexibility within primary care practices. The study findings further support the importance of employing a flexible study design, collaborating with healthcare personnel to develop customized workflow adjustments, tailoring implementation processes to accommodate the distinct requirements of two healthcare systems, and adjusting strategies to align with the objectives and priorities of the health systems.

Source: sciencedirect.com/science/article/abs/pii/S0885392423004633