I CAN DO Surgical ACP

Study Overview
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Brief Summary
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The goal of the Advanced Care Planning (ACP) study is to encourage patients aged 65 or older, or with serious illness, who are referred for major 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 electronic health record (HER)-centric pre-surgery workflow for older adults and including automated reminders, the study team can empower patients and surgical teams to engage in ACP discussions. Participants will be randomized to Arms: (1) Letter about ACP, PREPARE advanced directive (AD), PREPARE website; (2) Letter, advanced directive (AD), PREPARE plus reminder text/phone messages; (3) Letter, advanced directive (AD,) PREPARE plus reminders plus a healthcare navigator on ACP documentation (discussions and careplans, primary outcome) and patient-reported ACP engagement. Using mixed methods, the study team will assess patients' and surgical care teams' experience with surgery ACP.

Official Title
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I CAN DO Surgical ACP (Improving Completion, Accuracy, and Dissemination of Surgical Advanced Care Planning) Trial

Conditions
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Surgical Advanced Care Planning

Intervention / Treatment
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* Behavioral: Increasing intensity of ACP-related messaging prior to surgical visit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Older Adults (age 65+) or any patient with a serious illness referred for surgical evaluation Exclusion Criteria: ACP on file within 6 months prior to surgery Prior ACP-related patient portal messages from primary care (UCSF and UCI)

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Single Group Assignment
Interventional Model Description: 1:1 randomized block design stratified by enrollment site; within enrollment site, further stratified by surgical clinic
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Letter, AD, PREPARE<br>Letter about ACP, PREPARE advanced directive (AD), PREPARE website | Behavioral: Increasing intensity of ACP-related messaging prior to surgical visit<br>* Behavioral interventions to observe how the different arms of advanced care planning helps participants aged 65 or older.<br>|
| Other: Letter, AD, PREPARE, reminders<br>Letter, AD, PREPARE plus reminder text/phone messages | Behavioral: Increasing intensity of ACP-related messaging prior to surgical visit<br>* Behavioral interventions to observe how the different arms of advanced care planning helps participants aged 65 or older.<br>|
| Other: Letter, AD, PREPARE, reminders, healthcare naviagator, patient reported engagement<br>Letter, AD, PREPARE website plus reminders plus a healthcare navigator on ACP documentation (discussions and careplans, primary outcome) and patient-reported ACP engagement | Behavioral: Increasing intensity of ACP-related messaging prior to surgical visit<br>* Behavioral interventions to observe how the different arms of advanced care planning helps participants aged 65 or older.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with Advanced Care Planning | Advanced Directive (Living Will and Durable Power of Attorney) or out of hospital DNR or Physician Orders for Life-Sustaining Treatment or ACP note in EHR | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Engagement Scores | Self-assessed patient engagement levels will be measures using a 11 question survey. Participants will answer each question with responses that range from least likely to most likely, with each response converted to a numerical score. Scores range from 1 to 5, with higher scores indicating higher levels of patient engagement. | 6 months |