Evidence map›Paper›PMID 42574012›Full record

ArticleJAMA network open2026

Timing Prompts for Advance Care Planning Discussions and Advance Directive Completion.

Neil S Wenger, Fernando Javier Sanz Vidorreta, Chi-Hong Tseng, Victor Gonzalez, Ron D Hays, Maryam Rahimi, Lisa Gibbs, Katherine Santos, Rebecca L Sudore, Anne M Walling

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JAMA network open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Neil S WengerDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles.
Fernando Javier Sanz VidorretaDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles.
Chi-Hong TsengDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles.
Victor GonzalezDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles.
Ron D HaysDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles.
Maryam RahimiDivision of General Internal Medicine & Primary Care, Department of Medicine, University of California, Irvine.
Lisa GibbsDivision of Geriatric Medicine and Gerontology, Department of Family Medicine, University of California, Irvine.
Katherine SantosDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles.
Rebecca L SudoreDivision of Geriatrics, Department of Medicine, University of California, San Francisco.
Anne M WallingDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles.

Funding

Mentoring Researchers in Advance Care Planning for Underrepresented Older Adults at Risk for Alzheimer’s Disease and Related Dementias and Their CaregiversK24AG054415 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI REBECCA L SUDORE · 2017 to 2026
$1.7M
NIA NIH HHS K24 AG054415
6 · The paper itself

Abstract

Importance: Advance care planning (ACP) is recommended to ensure that medical care for patients with serious illness aligns with their goals; however, effective pragmatic strategies have been elusive. Objective: To compare the association of an appointment-based ACP behavioral intervention delivered with the patient just before a primary care visit vs a non-appointment-based intervention. Design, Setting, and Participants: Retrospective cohort study of patients from a cluster randomized trial of ACP interventions conducted October 2019 to June 2022 (data analysis June to November 2025). This included 50 primary care clinics across 3 academic health systems. Participants were primary care patients with serious illness 18 years and older without an advance directive (AD) or Physician Order for Life Sustaining Treatment (POLST) in the electronic health record (EHR). Exposure: Three different appointment-based automated ACP interventions delivered to patients 7 to 21 days before a primary care visit. Eligible patients who did not receive an appointment-based intervention received a non-appointment-based intervention after 6 months. Main Outcomes and Measures: Posthoc analysis of AD or POLST in the EHR at 12 and 24 months and documented patient-clinician ACP discussions by 24 months. Generalized estimating equation logistic regression models were used to compute adjusted differences. Results: Among the original study sample of 8707 patients, there were 5810 patients with no AD or POLST in the EHR at baseline (mean age 71 [15] years; 3017 [51.9%] male). Of these, 5435 (93.5%) received an ACP intervention by 24 months: 2842 patients (52.3%) received at least 1 appointment-based intervention, and 2593 (47.7%) received only non-appointment-based interventions. After 24 months, 475 patients (16.7%) receiving any appointment-based intervention had an AD or POLST in the EHR compared with 254 (9.8%) receiving only non-appointment-based interventions (adjusted difference, 6.5 percentage points [pp]; 95% CI, 4.9-8.2%. Among patients receiving appointment-based interventions, 1143 (40.2%) had ACP discussion documentation in the EHR compared with 714 (27.5%) of patients receiving only non-appointment-based interventions (adjusted difference, 12.2 pp; 95% CI, 8.7-15.6). Appointment-based interventions were associated with more AD or POLST and documented ACP discussions than non-appointment-based interventions across all 3 ACP intervention groups. Conclusions and Relevance: In this cohort of primary care patients with serious illness, an ACP intervention designed to engage patients and promote ACP discussions was associated with greater uptake if delivered before an office visit.

Indexed as

Advance Care PlanningAdvance DirectivesAppointments and SchedulesAdherence InterventionsAgedAged, 80 and overElectronic Health RecordsFemaleHumansMaleMiddle AgedPrimary Health CareRetrospective StudiesTime Factors

Identifiers

PMID42574012
PMCPMC13458875

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.