Study to Include Advanced Care Planning in EHR Presurgery Workflow

Aug. 31, 2023
‘I CAN DO Surgical ACP’ trial joins two other advanced care planning demonstration projects in NIH Pragmatic Trials Collaboratory portfolio

The NIH Pragmatic Trials Collaboratory has added a third study focused on improving advanced care planning to its portfolio of demonstration projects.

Despite advance care planning (ACP) being incorporated into national quality metrics and society guidelines for surgical care for older adults, the Collaboratory noted that effective integration of ACP into the presurgical phase remains uncommon. Efforts to date have mostly focused on improving surgeons’ use of ACP, but barriers remain significant, including lack of ACP familiarity, lack of appropriate patient-facing ACP tools, and lack of time dedicated to conversations around ACP during the presurgical period.

The I CAN DO Surgical ACP team has designed and tested a theory-based, interactive ACP patient-facing technology solution (PREPARE) based on a new ACP paradigm of preparing people for communication and medical decision-making. By including PREPARE in the electronic health record presurgery workflow for older adults and including automated reminders, the team expects that they can empower patients and surgical teams to engage in ACP discussions. The results of this study are the first step in ensuring optimal and patient-aligned medical decisions and communications for older adults undergoing surgery.

Elizabeth Wick, M.D., Genevieve Melton-Meaux M.D., and Rebecca Sudore, M.D., will serve as the co–principal investigators for I CAN DO Surgical ACP. Wick is a colorectal surgeon at the University of California, San Francisco Medical Center. Melton-Meaux is a professor of surgery, the senior associate dean of health informatics and data science, and the director of the Center for Learning Health System Sciences in the Institute for Health Informatics at the University of Minnesota. Sudore is a professor of medicine, the director of the Innovation and Implementation Center in Aging and Palliative Care, and a geriatrician at the University of California, San Francisco.

This new demonstration project is the third trial in the NIH Collaboratory portfolio to study an intervention designed to improve advanced care planning, following PROVEN and ACP PEACE.

The objective of PROVEN is to test the effect of an advance care planning video program on hospital transfers, burdensome treatments, and hospice enrollment among long-stay nursing home residents. ACP PEACE is testing a comprehensive ACP program for older adults with advanced cancer.