ArticleJournal of pain and symptom management2023
Implementation Challenges for a Multisite Advance Care Planning Pragmatic Trial: Lessons Learned.
Article in Journal of pain and symptom management, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
7 citing papers in PubMed.
- An Intervention to Increase Advance Care Planning Among Older Adults With Advanced Cancer: A Randomized Clinical Trial.JAMA network open · 2025Trial
- Core Elements of Goals of Care Initiatives Across Eight Health Systems.Journal of pain and symptom management · 2026Article
- Does Checklist-Guided Shared Decision Making Have a Sustained Effect on Code Status Decisions Among Medical Inpatients? Long-Term Follow Up of the Randomized CLEAR Checklist Trial.Journal of general internal medicine · 2026Article
- Evaluating the use of the consolidated framework for implementation research in primary care settings: a systematic review.Implementation science communications · 2026Review
- Using RE-AIM and CFIR to develop a subsidized doula program for at-risk underserved pregnant mothers.Frontiers in public health · 2026Article
- Barriers and Facilitators to the Implementation of Advance Care Planning: A Qualitative Study at National and Organizational Levels.Journal of evaluation in clinical practice · 2025Article
- Barriers and facilitators in implementing advance care planning for frail older patients acutely admitted to geriatric hospital units: a nested qualitative study.Frontiers in health services · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
background/problemAdvance care planning (ACP) pragmatic trials are needed. PROPOSED SOLUTION: We determined key system-level activities to implement ACP interventions for a cluster-randomized pragmatic trial. We identified patients with serious illness from 50 primary care clinics across three University of California health systems using a validated algorithm. If patients lacked documented ACP within the last 3 years, they were eligible for an intervention: (Arm 1) an advance directive (AD); (Arm 2) AD + PREPAREforYourCare.org; (Arm 3) AD + PREPARE + lay health navigator outreach. Triggered by an appointment, we mailed and sent interventions through automated electronic health record (EHR) messaging. We collaborated with patients/caregivers, clinicians, payors, and national/health system leader advisors. We are currently finalizing 24 months follow-up data. OUTCOMES/
methodsWe used the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) frameworks to track secular trends and implementation efforts. KEY MESSAGE/
resultsRequired multisite, system-level activities: 1) obtaining leadership, legal/privacy, and EHR approvals; 2) standardizing ACP documentation; 3) providing clinician education; 3) validating an automated serious illness identification algorithm; 4) standardizing ACP messaging with input from over 100 key advisors; 5) monitoring secular trends (e.g., COVID); and 6) standardizing ACP workflows (e.g., scanned ADs). Of 8707 patients with serious illness, 6883 were eligible for an intervention. Across all arms, 99% received the mailed intervention, 78.3% had an active patient portal (64.2% opened intervention), and 90.5% of arm three patients (n = 2243) received navigator outreach. LESSONS LEARNED: Implementing a multisite health system-wide ACP program and pragmatic trial, with automated EHR-based cohort identification and intervention delivery, requires a high level of multidisciplinary key advisor engagement, standardization, and monitoring. These activities provide guidance for the implementation of other large-scale, population-based ACP efforts.
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Registered trials
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