Results Summary

What was the research about?

Advance care planning, or ACP, is a process that helps adults think about and discuss their personal values, life goals, and wishes for future health care. With ACP, patients with serious illness can share their care preferences with their primary care doctor. But ACP isn’t always part of primary care for patients with a serious illness.

In this study, the research team compared two approaches to provide ACP as part of primary care to patients with a serious illness:

  • Individual doctors. Primary care doctors provided ACP to patients. Doctors took an online education program on how to talk about ACP with patients and their families. They also had a class with coaching and role-play to practice these conversations.
  • Clinic team. Primary care doctors and at least one other clinic staff member provided ACP. Staff could include nurses, care managers, social workers, medical assistants, or counselors. The staff members took the same online education program. They also received training on ACP and its goals, communicating with team members, and knowing the strengths and limits of each team member.

The research team wanted to learn which approach helped patients receive care that matched their goals and the number of days patients spent at home.

What were the results?

After six months, patients receiving ACP from individual doctors or a clinic team didn’t differ in:

  • Receipt of care that matched patients’ goals
  • Number of days spent at home out of the hospital, nursing home, or rehab center
  • Symptoms of anxiety and depression

Most patients in both groups who received ACP from individual doctors (63 percent) or from a clinic team (57 percent) said they received care that matched their goals.

Who was in the study?

The study included 802 patients with a serious illness who were at risk for dying or being unable to make decisions in two years. Among patients, 87 percent were White, 4 percent were Black, 2 percent were Asian, 2 percent were Hispanic, and 2 percent were another race. Also, 64 percent were over age 75 and 59 percent were women. All received care from one of 40 clinics across the United States and Canada.

What did the research team do?

The research team assigned clinics by chance to one of the two approaches. Patients completed surveys at the start of the study and 6 months later.

Patients and caregivers gave input during the study.

What were the limits of the study?

In both approaches, the research team let practices adjust how they gave ACP to patients. Researchers don’t have a standard way to measure how well care matches what is important to patients. These factors may have limited the team’s ability to detect differences between approaches.

Future research could create a standard way to measure how well care matches what is most important to patients.

How can people use the results?

Primary care clinics can use these results when considering adding ACP to their standard care for patients with a serious illness.

Final Research Report

This project's final research report is expected to be available by December 2024.

Engagement Resources

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 requested that the researchers provide more information in the report about the interventions and the outcome measures. The researchers expanded their description of the Serious Illness Care Plan (SICP) intervention and the differences between the team-based and clinician-based models. They also expanded their descriptions of the outcome measures and how they were analyzed.
  • The reviewers noted that the study conclusions generally were consistent with the results, but the researchers could say more about whether the results showed any clinical significance. The researchers presented conclusions that they did not see clinically meaningful differences between the intervention groups on goal-concordant care (GCC) or on days at home over the six months of the study. The high rates of GCC and the dearth of hospitalizations during those six months left little room for variability between groups that could be clinically important.
  • The reviewers also asked the researchers to reconsider their statements that imply that high levels of GCC and low rates of hospitalization resulted from the SICP intervention in both study arms, noting that the lack of a no-treatment arm in the study would not allow the researchers to conclude that the improvements seen in both study arms were the result of the interventions rather than naturally occurring change over time. The researchers made appropriate revisions to remove causal language.

Conflict of Interest Disclosures

Project Information

Annette M. Totten, PhD
France Légaré, MD, PhD
Oregon Health & Science University
$8,229,184
A Cluster-Randomized Trial Comparing Team-Based versus Primary Care Clinician-Focused Advance Care Planning in Practice-Based Research Networks

Key Dates

July 2017
July 2023
2017
2024

Study Registration Information

Tags

Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
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
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
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 26, 2024