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  1. Article ; Online: Forms or Free-Text? Measuring Advance Care Planning Activity Using Electronic Health Records.

    Zupanc, Sophia N / Lakin, Joshua R / Volandes, Angelo E / Paasche-Orlow, Michael K / Moseley, Edward T / Gundersen, Daniel A / Das, Sophiya / Penumarthy, Akhila / Martins-Welch, Diana / Burns, Edith A / Carney, Maria T / Itty, Jennifer E / Emmert, Kaitlin / Tulsky, James A / Lindvall, Charlotta

    Journal of pain and symptom management

    2023  Volume 66, Issue 5, Page(s) e615–e624

    Abstract: Advance care planning (ACP) discussions seek to guide future serious illness care. These discussions may be recorded in the electronic health record by documentation in clinical notes, structured forms and directives, and physician orders. Yet, most ... ...

    Abstract Advance care planning (ACP) discussions seek to guide future serious illness care. These discussions may be recorded in the electronic health record by documentation in clinical notes, structured forms and directives, and physician orders. Yet, most studies of ACP prevalence have only examined structured electronic health record elements and ignored data existing in notes. We sought to investigate the relative comprehensiveness and accuracy of ACP documentation from structured and unstructured electronic health record data sources. We evaluated structured and unstructured ACP documentation present in the electronic health records of 435 patients with cancer drawn from three separate healthcare systems. We extracted structured ACP documentation by manually annotating written documents and forms scanned into the electronic health record. We coded unstructured ACP documentation using a rule-based natural language processing software that identified ACP keywords within clinical notes and was subsequently reviewed for accuracy. The unstructured approach identified more instances of ACP documentation (238, 54.7% of patients) than the structured ACP approach (187, 42.9% of patients). Additionally, 16.6% of all patients with structured ACP documentation only had documents that were judged as misclassified, incomplete, blank, unavailable, or a duplicate of a previously entered erroneous document. ACP documents scanned into electronic health records represent a limited view of ACP activity. Research and measures of clinical practice with ACP should incorporate information from unstructured data.
    Language English
    Publishing date 2023-08-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 639142-4
    ISSN 1873-6513 ; 0885-3924
    ISSN (online) 1873-6513
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2023.07.016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Video Intervention and Goals-of-Care Documentation in Hospitalized Older Adults: The VIDEO-PCE Randomized Clinical Trial.

    Volandes, Angelo E / Zupanc, Sophia N / Lakin, Joshua R / Cabral, Howard J / Burns, Edith A / Carney, Maria T / Lopez, Santiago / Itty, Jennifer / Emmert, Kaitlin / Martin, Narda J / Cole, Therese / Dobie, Alexandra / Cucinotta, Traci / Joel, Milton / Caruso, Lisa B / Henault, Lori / Dugas, Julianne N / Astone, Kristina / Winter, Michael /
    Wang, Na / Davis, Aretha Delight / Garde, Cynthia / Rodriguez, Perla Macip / El-Jawahri, Areej / Moseley, Edward T / Das, Sophiya / Sciacca, Kate / Ramirez, Ana Maria / Gromova, Valeria / Lambert, Sherene / Sanghani, Shreya / Lindvall, Charlotta / Paasche-Orlow, Michael K

    JAMA network open

    2023  Volume 6, Issue 9, Page(s) e2332556

    Abstract: Importance: Despite the benefits of goals-of-care (GOC) communication, many hospitalized individuals never communicate their goals or preferences to clinicians.: Objective: To assess whether a GOC video intervention delivered by palliative care ... ...

    Abstract Importance: Despite the benefits of goals-of-care (GOC) communication, many hospitalized individuals never communicate their goals or preferences to clinicians.
    Objective: To assess whether a GOC video intervention delivered by palliative care educators (PCEs) increased the rate of GOC documentation.
    Design, setting, and participants: This pragmatic, stepped-wedge cluster randomized clinical trial included patients aged 65 years or older admitted to 1 of 14 units at 2 urban hospitals in New York and Boston from July 1, 2021, to October 31, 2022.
    Intervention: The intervention involved PCEs (social workers and nurses trained in GOC communication) facilitating GOC conversations with patients and/or their decision-makers using a library of brief, certified video decision aids available in 29 languages. Patients in the control period received usual care.
    Main outcome and measures: The primary outcome was GOC documentation, which included any documentation of a goals conversation, limitation of life-sustaining treatment, palliative care, hospice, or time-limited trials and was obtained by natural language processing.
    Results: A total of 10 802 patients (mean [SD] age, 78 [8] years; 51.6% male) were admitted to 1 of 14 hospital units. Goals-of-care documentation during the intervention phase occurred among 3744 of 6023 patients (62.2%) compared with 2396 of 4779 patients (50.1%) in the usual care phase (P < .001). Proportions of documented GOC discussions for Black or African American individuals (865 of 1376 [62.9%] vs 596 of 1125 [53.0%]), Hispanic or Latino individuals (311 of 548 [56.8%] vs 218 of 451 [48.3%]), non-English speakers (586 of 1059 [55.3%] vs 405 of 863 [46.9%]), and people living with Alzheimer disease and related dementias (520 of 681 [76.4%] vs 355 of 570 [62.3%]) were greater during the intervention phase compared with the usual care phase.
    Conclusions and relevance: In this stepped-wedge cluster randomized clinical trial of older adults, a GOC video intervention delivered by PCEs resulted in higher rates of GOC documentation compared with usual care, including among Black or African American individuals, Hispanic or Latino individuals, non-English speakers, and people living with Alzheimer disease and related dementias. The findings suggest that this form of patient-centered care delivery may be a beneficial decision support tool.
    Trial registration: ClinicalTrials.gov Identifier: NCT04857060.
    MeSH term(s) Humans ; Male ; Aged ; Female ; Alzheimer Disease ; Goals ; Communication ; Documentation ; Palliative Care
    Language English
    Publishing date 2023-09-05
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2023.32556
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Association of an Advance Care Planning Video and Communication Intervention With Documentation of Advance Care Planning Among Older Adults: A Nonrandomized Controlled Trial.

    Volandes, Angelo E / Zupanc, Sophia N / Paasche-Orlow, Michael K / Lakin, Joshua R / Chang, Yuchiao / Burns, Edith A / LaVine, Nancy A / Carney, Maria T / Martins-Welch, Diana / Emmert, Kaitlin / Itty, Jennifer E / Moseley, Edward T / Davis, Aretha D / El-Jawahri, Areej / Gundersen, Daniel A / Fix, Gemmae M / Yacoub, Andrea M / Schwartz, Pamela / Gabry-Kalikow, Shira /
    Garde, Cynthia / Fischer, Jonathan / Henault, Lori / Burgess, Leah / Goldman, Julie / Kwok, Anne / Singh, Nimisha / Alvarez Suarez, Armando L / Gromova, Valeria / Jacome, Sonia / Tulsky, James A / Lindvall, Charlotta

    JAMA network open

    2022  Volume 5, Issue 2, Page(s) e220354

    Abstract: Importance: COVID-19 has disproportionately killed older adults and racial and ethnic minority individuals, raising questions about the relevance of advance care planning (ACP) in this population. Video decision aids and communication skills training ... ...

    Abstract Importance: COVID-19 has disproportionately killed older adults and racial and ethnic minority individuals, raising questions about the relevance of advance care planning (ACP) in this population. Video decision aids and communication skills training offer scalable delivery models.
    Objective: To assess whether ACP video decision aids and a clinician communication intervention improved the rate of ACP documentation during an evolving pandemic, with a focus on African American and Hispanic patients.
    Design, setting, and participants: The Advance Care Planning: Communicating With Outpatients for Vital Informed Decisions trial was a pre-post, open-cohort nonrandomized controlled trial that compared ACP documentation across the baseline pre-COVID-19 period (September 15, 2019, to March 14, 2020), the COVID-19 wave 1 period (March 15, 2020, to September 14, 2020), and an intervention period (December 15, 2020, to June 14, 2021) at a New York metropolitan area ambulatory network of 22 clinics. All patients 65 years or older who had at least 1 clinic or telehealth visit during any of the 3 study periods were included.
    Main outcomes and measures: The primary outcome was ACP documentation.
    Results: A total of 14 107 patients (mean [SD] age, 81.0 [8.4] years; 8856 [62.8%] female; and 2248 [15.9%] African American or Hispanic) interacted with clinicians during the pre-COVID-19 period; 12 806 (mean [SD] age, 81.2 [8.5] years; 8047 [62.8%] female; and 1992 [15.6%] African American or Hispanic), during wave 1; and 15 106 (mean [SD] 80.9 [8.3] years; 9543 [63.2%] female; and 2535 [16.8%] African American or Hispanic), during the intervention period. Clinicians documented ACP in 3587 patients (23.8%) during the intervention period compared with 2525 (17.9%) during the pre-COVID-19 period (rate difference [RD], 5.8%; 95% CI, 0.9%-7.9%; P = .01) and 1598 (12.5%) during wave 1 (RD, 11.3%; 95% CI, 6.3%-12.1%; P < .001). Advance care planning was documented in 447 African American patients (30.0%) during the intervention period compared with 233 (18.1%) during the pre-COVID-19 period (RD, 11.9%; 95% CI, 4.1%-15.9%; P < .001) and 130 (11.0%) during wave 1 (RD, 19.1%; 95% CI, 11.7%-21.2%; P < .001). Advance care planning was documented for 222 Hispanic patients (21.2%) during the intervention period compared with 127 (13.2%) during the pre-COVID-19 period (RD, 8.0%; 95% CI, 2.1%-10.9%; P = .004) and 82 (10.2%) during wave 1 (RD, 11.1%; 95% CI, 5.5%-14.5%; P < .001).
    Conclusions and relevance: This intervention, implemented during the evolving COVID-19 pandemic, was associated with higher rates of ACP documentation, especially for African American and Hispanic patients.
    Trial registration: ClinicalTrials.gov Identifier: NCT04660422.
    MeSH term(s) Advance Care Planning/statistics & numerical data ; African Americans/statistics & numerical data ; Aged ; Aged, 80 and over ; COVID-19 ; Clinical Decision-Making ; Cohort Studies ; Female ; Hispanic or Latino/statistics & numerical data ; Humans ; Male ; New York/epidemiology ; Patient Education as Topic ; Videotape Recording
    Language English
    Publishing date 2022-02-01
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, N.I.H., Extramural
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2022.0354
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Study protocol for Video Images about Decisions to Improve Ethical Outcomes with Palliative Care Educators (VIDEO-PCE): a pragmatic stepped wedge cluster randomised trial of older patients admitted to the hospital

    Lakin, Joshua R / Zupanc, Sophia N / Lindvall, Charlotta / Moseley, Edward T / Das, Sophiya / Sciacca, Kate / Cabral, Howard J / Burns, Edith A / Carney, Maria T / Itty, Jennifer / Lopez, Santiago / Emmert, Kaitlin / Martin, Narda J / Lambert, Sherene / Polo, Jennifer / Sanghani, Shreya / Dugas, Julianne N / Gomez, Michele / Winter, Michael R /
    Wang, Na / Gabry-Kalikow, Shira / Dobie, Alexandra / Amshoff, Meredith / Cucinotta, Traci / Joel, Milton / Caruso, Lisa B / Ramirez, Ana Maria / Salerno, Kathleen / Ogunneye, Qausarat / Henault, Lori / Davis, Aretha Delight / Volandes, Angelo / Paasche-Orlow, Michael K

    BMJ open

    2022  Volume 12, Issue 7, Page(s) e065236

    Abstract: Introduction: Despite the known benefit to patients and families, discussions about goals, values and preferences for medical care in advancing serious illness often do not occur. Many system and clinician factors, such as patient and clinician ... ...

    Abstract Introduction: Despite the known benefit to patients and families, discussions about goals, values and preferences for medical care in advancing serious illness often do not occur. Many system and clinician factors, such as patient and clinician reticence and shortage of specialty palliative care teams, contribute to this lack of communication. To address this gap, we designed an intervention to promote goals-of-care conversations and palliative care referrals in the hospital setting by using trained palliative care educators and video decision aids. This paper presents the rationale, design and methods for a trial aimed at addressing barriers to goals-of-care conversations for hospitalised adults aged 65 and older and those with Alzheimer's disease and related Dementias, regardless of age.
    Methods and analysis: The Video Image about Decisions to Improve Ethical Outcomes with Palliative Care Educators is a pragmatic stepped wedge, cluster randomised controlled trial, which aims to improve and extend goals-of-care conversations in the hospital setting with palliative care educators trained in serious illness communication and video decision aids. The primary outcome is the proportion of patients with goals-of-care documentation in the electronic health record. We estimate that over 9000 patients will be included.
    Ethics and dissemination: The Institutional Review Board (IRB) at Boston Medical Center will serve as the single IRB of record for all regulatory and ethical aspects of this trial. BMC Protocol Number: H-41482. Findings will be presented at national meetings and in publications. This trial is registered at ClinicalTrials.gov.
    Trial registration number: NCT04857060; ClinicalTrials.gov.
    MeSH term(s) Adult ; Communication ; Hospice and Palliative Care Nursing ; Hospitalization ; Hospitals ; Humans ; Palliative Care ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2022-07-25
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2022-065236
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