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| ID | Type | Description | Link |
|---|---|---|---|
| 1UG3AG081663-01 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| University of California, Irvine | OTHER |
| University of Minnesota | OTHER |
| National Institute on Aging (NIA) | NIH |
| Fairview University Medical Center |
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The goal of the Advanced Care Planning (ACP) study is to encourage patients aged 65 or older who are referred for elective surgery to have advanced care planning.
ACP is also a critical way to support older adults in participating actively with clinicians in making real-time, complex medical decisions so that the medical care they receive is aligned with their goals. Our team has designed and tested a theory-based, interactive ACP patient-facing technology solution (PREPARE) based on the new ACP paradigm of preparing people for communication and medical decision-making. The study team hypothesizes that by including PREPARE into the EHR-centric pre-surgery workflow for older adults and including automated patient reminders, easy-to-read materials, and, in Arm 3, directed support from a healthcare navigator (HCN), they can empower patients and surgical teams to engage in ACP discussions. They also hypothesize that ACP documentation will increase more with increasing resource intensity (i.e., Arm 3 more than Arm 2 more than Arm 1).
Participants will be randomized to Arms: (1) Letter about ACP, PREPARE advanced directive (AD), PREPARE website; (2) Letter, advanced directive (AD), PREPARE plus reminder messages; (3) Letter, advanced directive (AD,) PREPARE plus reminders plus a healthcare navigator on ACP documentation (clinically meaningful ACP, primary outcome). All patients randomized to the intervention will be sent a patient-reported ACP engagement survey (secondary outcome).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Letter, AD, PREPARE | Other | Letter about ACP, PREPARE advanced directive (AD), PREPARE website |
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| Letter, AD, PREPARE, reminders | Other | Letter, AD, PREPARE plus reminder messages |
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| Letter, AD, PREPARE, reminders, healthcare navigator | Other | Letter, AD, PREPARE website plus reminders plus a healthcare navigator on ACP documentation (clinically meaningful ACP, primary outcome) |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Letter | Behavioral | Letter about ACP |
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| Measure | Description | Time Frame |
|---|---|---|
| Number of participants with clinically meaningful Advanced Care Planning | clinically meaningful ACP documentation (ACP-specific clinical notes, problem lists, Epic Smartforms or Smartphrases, advanced directives, Physician Orders for Life Sustaining Treatment, out of hospital do-not-resuscitate order, living wills, or CPT billing codes) available in the HCS EHR within 6 months of intervention. | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Patient Engagement Scores | Patient-centered outcomes will be derived from the validated 4-item ACP Engagement Survey.The survey will be administered 2 weeks after the pre-surgical clinic visit and a follow up survey will be sent 6 months later. | 6 months |
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Inclusion Criteria:
- Older Adults (age 65+) referred for surgical evaluation
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Elizabeth Wick, MD | Contact | 415-353-2357 | Elizabeth.wick@ucsf.edu | |
| Irina Gorodetskaya | Contact | 415-514-7430 | Irina.Gorodetskaya@ucsf.edu |
| Name | Affiliation | Role |
|---|---|---|
| Elizabeth Wick, MD | University of California, San Francisco | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California, Irvine | Recruiting | Irvine | California | 92697 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40987739 | Derived | Welton L, Colley A, Sudore RL, Melton GB, Botsford C, Oreper S, O'Brien SE, Koopmeiners JS, Gibbs L, Carmichael JC, Wick EC. I CAN DO Surgical ACP (Improving Completion, Accuracy and Dissemination of Surgical Advanced Care Planning): a protocol for a multisite, single-blinded, pragmatic randomised controlled trial to improve ACP completion in older adults in the presurgical setting. BMJ Open. 2025 Sep 23;15(9):e108850. doi: 10.1136/bmjopen-2025-108850. |
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De-identified data sets are available at request at the conclusion of the study
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| ID | Term |
|---|---|
| D065822 | College Fraternities and Sororities |
| ID | Term |
|---|---|
| D009938 | Organizations |
| D004472 | Health Care Economics and Organizations |
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| OTHER |
1:1:1 simple randomized block design stratified by enrollment site
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| AD | Behavioral | PREPARE advanced directive (AD) |
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| PREPARE website | Behavioral | PREPARE website |
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| reminders | Behavioral | reminders to complete the advance directive |
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| healthcare navigator | Behavioral | healthcare navigators provide assistance to complete the advance directive |
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| University of California, San Francisco | Recruiting | San Francisco | California | 94143 | United States |
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| University of Minnesota | Recruiting | Minneapolis | Minnesota | 55455 | United States |
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