SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care

Sydney M Dy, Daniel L Scerpella, Valerie Cotter, Jessica Colburn, David L Roth, Maura McGuire, Erin Rand Giovannetti, Kathryn A Walker, Naaz Hussain, Danetta H Sloan, Cynthia M Boyd, Kimberley Cockey, Neha Sharma, Martha Abshire Saylor, Kelly M Smith, Jennifer L Wolff, SHARING Choices investigators, Ryan Anderson, Diane Echavarria, Tara Funkhouser, Karyn Lee Carlson Nicholson, Christine Rawlinson, Sri Ribala, Meena Seshamani, Laura Torres, Sydney M Dy, Daniel L Scerpella, Valerie Cotter, Jessica Colburn, David L Roth, Maura McGuire, Erin Rand Giovannetti, Kathryn A Walker, Naaz Hussain, Danetta H Sloan, Cynthia M Boyd, Kimberley Cockey, Neha Sharma, Martha Abshire Saylor, Kelly M Smith, Jennifer L Wolff, SHARING Choices investigators, Ryan Anderson, Diane Echavarria, Tara Funkhouser, Karyn Lee Carlson Nicholson, Christine Rawlinson, Sri Ribala, Meena Seshamani, Laura Torres

Abstract

Background: Advance care planning (ACP) and involving family are particularly important in dementia, and primary care is a key setting. The purpose of this trial is to examine the impact and implementation of SHARING Choices, an intervention to improve communication for older adults with and without dementia through proactively supporting ACP and family engagement in primary care.

Methods: We cluster-randomized 55 diverse primary care practices across two health systems to the intervention or usual care. SHARING Choices is a multicomponent intervention that aims to improve communication through patient and family engagement in ACP, agenda setting, and shared access to the patient portal for all patients over 65 years of age. The primary outcomes include documentation of an advance directive or medical orders for life-sustaining treatment in the electronic health record (EHR) at 12 months for all patients and receipt of potentially burdensome care within 6 months of death for the subgroup of patients with serious illness. We plan a priori sub-analysis for patients with dementia. Data sources include the health system EHRs and the Maryland health information exchange. We use a mixed-methods approach to evaluate uptake, fidelity and adaptation of the intervention and implementation facilitators and barriers.

Conclusions: This cluster-randomized pragmatic trial examines ACP with a focus on the key population of those with dementia, implementation in diverse settings and innovative approaches to trial design and outcome abstraction. Mixed-methods approaches enable understanding of intervention delivery and facilitators and barriers to implementation in rapidly changing health care systems.

Clinicaltrials: gov Identifier: NCT04819191.

Keywords: Advance care planning; Advance directives; Dementia; Primary care.

Conflict of interest statement

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2022 Elsevier Inc. All rights reserved.

Figures

Fig. 1.
Fig. 1.
Content of outreach letter to patients [Johns Hopkins version).
Fig. 2.
Fig. 2.
Agenda-setting checklist (Johns Hopkins version).

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