Final Research Report

View this project's final research report.

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Study Protocol

View this project's study protocol.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers questioned whether the study was really an efficacy study since the outcomes were about process of care rather than clinical change. The researchers responded that the study measured the efficacy of the intervention on changes in goals-of-care discussions as the primary outcome, a process outcome.
  • The reviewers asked researchers for additional rationale for including anxiety and depression symptoms as study outcomes. The researchers responded that interventions to improve communication often lead to reductions in anxiety and depression symptoms. Therefore, these outcomes are relevant.
  • The reviewers expressed concern about the low participation rate among clinicians as well as cross-contamination since the same clinicians cared for both intervention and nonintervention patients. The researchers acknowledged the low participation rate, noting that it was similar to other studies enrolling physicians in communications interventions. They also noted that the participating clinics were not organized to support clinician involvement. Few clinicians in these clinics considered goals-of-care communication to be part of their patient care responsibilities. The researchers also acknowledged that this low participation rate did raise concerns about generalizability of the intervention to other busy medical practices.
  • The reviewers expressed concern about the qualitative portion of the report, finding it underdeveloped, with little description of the analyses and results. The researchers noted that the goal of the qualitative work was to provide another perspective on the findings in the report. The investigators provided additional detail in this section.

Conflict of Interest Disclosures

Project Information

J. Randall Curtis, MD, MPH
University of Washington
Health System Intervention to Improve Communication About End-of-Life Care for Vulnerable Patients

Key Dates

May 2013
October 2018

Study Registration Information


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Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
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Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: March 4, 2022