A program consisting of video decision aids for patients and communication skills training for clinicians was associated with higher rates of documentation of advance care planning among older adults, especially African American and Hispanic patients, in a recent study from the NIH Pragmatic Trials Collaboratory.

The COVID-19 pandemic has led to disproportionately higher death rates among older adults and racial and ethnic minority groups. Improving access to advance care planning for these groups, as in other high-risk populations, could help patients receive care that reflects what matters most to them.

The Advance Care Planning: Communicating With Outpatients for Vital Informed Decisions (ACP-COVID) study was a pre-post, open-cohort nonrandomized controlled trial comparing rates of advance care planning documentation among older patients in an ambulatory care network of 22 clinics in the New York City metropolitan area. Outcomes were measured during a 6-month pre–COVID-19 baseline period, a 6-month period during the first wave of the COVID-19 public health emergency, and a 6-month intervention period.

The study’s results were published in JAMA Network Open.

Video decision aids were shared with all patients 65 years or older up to 2 weeks before an in-person or telehealth appointment in the participating clinics. The videos addressed choosing a healthcare proxy, having an advance care planning conversation, and information about COVID-19 and vaccinations. Communication skills training was offered to all clinicians in the practices.

Rates of advance care planning documentation were much higher during the intervention period compared with the 2 other study periods. In addition, African American and Hispanic patients were more likely than non-Hispanic White patients to have advance care planning documentation during the intervention period, groups which also had higher exposure to serious COVID-19 illness during the study.

Watch a recent COVID-19 Grand Rounds session about the ACP-COVID study.

ACP-COVID was supported within the NIH Pragmatic Trials Collaboratory by the NIH Common Fund through a cooperative agreement for the ACP-PEACE NIH Collaboratory Trial from the National Institute on Aging and by supplemental funding from the Office of Strategic Coordination within the Office of the NIH Director. Learn more about ACP PEACE.