improving communication for primary care patients

Conditions: Advance Care Planning; Dementia

Summary: this is a pragmatic trial of sharing choices. components of sharing choices include: 1. a letter from the clinic introducing an initiative to prepare persons and families for advance care planning (acp); 2. access to a facilitator trained to lead acp discussions; 3. patient-family agenda-setting to align perspectives about the role of family and stimulate discussion about acp; 4. facilitated registration to the patient portal (for patient and family) as desired; 5. education \& resources about alzheimer's disease and related dementias (adrd) for clinic staff.

engaging family in primary care is particularly important in alzheimer's disease and related dementias (adrd) because of the important role assumed in medical decision-making, especially at the end of life. the investigators, study seeks to improve communication in primary care through methods to proactively engage family in ongoing interactions with primary care and stimulate and support advance care planning (acp) for all older adults and attention to adrd in primary care throughout the adrd disease trajectory. the investigators' premise is that individuals and families appreciate primary care involvement in acp and information and referrals for adrd needs, but that individual, family, and system factors including time, knowledge, and resources often inhibit these conversations from occurring. sharing choices integrates communication strategies that have been individually found to be effective but have thus far been deployed in isolation of one another. the investigators focus on all older primary care patients because of the importance of addressing acp early, the under-diagnosis of adrd and the greater implementation potential of a protocol with broad applicability. components of sharing choices include: 1. a letter from the clinic introducing an initiative to prepare persons and families for advance care planning (acp); 2. access to a facilitator trained to lead acp discussions; 3. patient-family agenda-setting to align perspectives about the role of family and stimulate discussion about acp; 4. facilitated registration to the patient portal (for patient and family) as desired; 5. education \& resources about adrd for clinic staff.

Eligibility criteria:
inclusion criteria: practices included in this trial are: * affiliated with johns hopkins community physicians (jhcp) or medstar health; * a primary care practice, defined as adult internal medicine, family medicine, or geriatric medicine; * have 2 or more practicing clinicians; and * have more than 500 patients aged 65 and over currently receiving care. patients included in this trial are: * age 65 and older, and * established patient of primary care clinician at participating practice (\>1 prior visit at the clinic). there will be no formal enrollment of participants into this pragmatic trial as this is a clinic-level initiative that will be available and offered to all eligible patients at clinics randomized to the intervention. exclusion criteria: primary care practices affiliated with johns hopkins community physicians (jhcp) or medstar health that are: * not a primary care practice, defined as adult internal medicine, family medicine, or geriatric medicine; * have fewer than 2 practicing clinicians; and * have fewer than 500 patients aged 65 and over currently receiving care. patients under the care of primary care practices affiliated with johns hopkins community physicians (jhcp) or medstar health that are: * less than 65 years of age, or * not established patients.