Randomized Controlled Trial

. 2022 Aug:119:106818.

doi: 10.1016/j.cct.2022.106818. Epub 2022 Jun 8.

SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care

Sydney M Dy¹, Daniel L Scerpella², Valerie Cotter³, Jessica Colburn⁴, David L Roth⁵, Maura McGuire⁶, Erin Rand Giovannetti⁷, Kathryn A Walker⁸, Naaz Hussain⁹, Danetta H Sloan¹⁰, Cynthia M Boyd¹¹, Kimberley Cockey¹², Neha Sharma¹³, Martha Abshire Saylor¹⁴, Kelly M Smith¹⁵, Jennifer L Wolff¹⁶; SHARING Choices investigators

Collaborators, Affiliations

Collaborators

SHARING Choices investigators:
Ryan Anderson¹⁷, Diane Echavarria¹⁸, Tara Funkhouser¹⁹, Karyn Lee Carlson Nicholson²⁰, Christine Rawlinson²¹, Sri Ribala²², Meena Seshamani²³, Laura Torres²⁴

Affiliations

¹ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: dy1@jhu.edu.
² Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: dscerpe1@jhu.edu.
³ Johns Hopkins School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205, USA. Electronic address: vcotter1@jhu.edu.
⁴ Division of Geriatric Medicine & Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 2200, Baltimore, MD 21224, USA. Electronic address: jcolbur1@jhmi.edu.
⁵ Center on Aging and Health, Division of Geriatric Medicine and Gerontology, 2024 East Monument Street, Baltimore, MD 21205, USA. Electronic address: droth@jhu.edu.
⁶ Johns Hopkins Community Physicians, 2700 Remington Ave, Suite 2000, Baltimore, MD 21211, USA. Electronic address: mmcguir1@jhmi.edu.
⁷ Health Economics and Aging Research Institute, MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Erin.giovannetti@medstar.net.
⁸ MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Kathryn.A.Walker@medstar.net.
⁹ Johns Hopkins Community Physicians, 45 TJ Drive, Suite 109, Frederick, MD 21702, USA. Electronic address: nhussai1@jhmi.edu.
¹⁰ Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: dhendr11@jhu.edu.
¹¹ Division of Geriatric Medicine & Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 2200, Baltimore, MD 21224, USA. Electronic address: cyboyd@jhmi.edu.
¹² MedStar Health Institute for Quality and Safety, MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Kimberly.L.Cockey@Medstar.net.
¹³ MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Neha.k.sharma@medstar.net.
¹⁴ Johns Hopkins School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205, USA. Electronic address: mabshir1@jhu.edu.
¹⁵ MedStar Health Institute for Quality and Safety, MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Kelly.Smith@tehn.ca.
¹⁶ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: jwolff2@jhu.edu.
¹⁷ MedStar Health, 10980 Granchester Way, Columbia, MD 21044, USA. Electronic address: ryan.anderson@medstar.net.
¹⁸ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: dechava1@jhu.edu.
¹⁹ Johns Hopkins Medicine, 15,627 Clear Spring Rd, Williamsport, MD 21795, USA. Electronic address: tfunkho1@jhmi.edu.
²⁰ Johns Hopkins Medicine Office of Population Health, 750 E Pratt Street 5th floor, Baltimore, MD 21202, USA. Electronic address: knicho25@jhmi.edu.
²¹ Johns Hopkins Community Physicians, Mt. Washington Campus - Marbury Building, 6225 Smith Avenue, Suite B-300, Baltimore, MD 21209-3600, USA. Electronic address: crawlin8@jhmi.edu.
²² MedStar Health, 10,980 Granchester Way, Columbia, MD 21044, USA. Electronic address: sri.ribala@medstar.net.
²³ MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA.
²⁴ Population Health Infrastructure, Johns Hopkins Medical Institutions, 5755 Cedar Ln, Columbia, MD 21044, USA. Electronic address: ltorres6@jhmi.edu.

PMID: 35690262
PMCID: PMC9700199
DOI: 10.1016/j.cct.2022.106818

Randomized Controlled Trial

SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care

Sydney M Dy et al. Contemp Clin Trials. 2022 Aug.

. 2022 Aug:119:106818.

doi: 10.1016/j.cct.2022.106818. Epub 2022 Jun 8.

Authors

Collaborators

SHARING Choices investigators:
Ryan Anderson¹⁷, Diane Echavarria¹⁸, Tara Funkhouser¹⁹, Karyn Lee Carlson Nicholson²⁰, Christine Rawlinson²¹, Sri Ribala²², Meena Seshamani²³, Laura Torres²⁴

Affiliations

¹ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: dy1@jhu.edu.
² Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: dscerpe1@jhu.edu.
³ Johns Hopkins School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205, USA. Electronic address: vcotter1@jhu.edu.
⁴ Division of Geriatric Medicine & Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 2200, Baltimore, MD 21224, USA. Electronic address: jcolbur1@jhmi.edu.
⁵ Center on Aging and Health, Division of Geriatric Medicine and Gerontology, 2024 East Monument Street, Baltimore, MD 21205, USA. Electronic address: droth@jhu.edu.
⁶ Johns Hopkins Community Physicians, 2700 Remington Ave, Suite 2000, Baltimore, MD 21211, USA. Electronic address: mmcguir1@jhmi.edu.
⁷ Health Economics and Aging Research Institute, MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Erin.giovannetti@medstar.net.
⁸ MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Kathryn.A.Walker@medstar.net.
⁹ Johns Hopkins Community Physicians, 45 TJ Drive, Suite 109, Frederick, MD 21702, USA. Electronic address: nhussai1@jhmi.edu.
¹⁰ Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: dhendr11@jhu.edu.
¹¹ Division of Geriatric Medicine & Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 2200, Baltimore, MD 21224, USA. Electronic address: cyboyd@jhmi.edu.
¹² MedStar Health Institute for Quality and Safety, MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Kimberly.L.Cockey@Medstar.net.
¹³ MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Neha.k.sharma@medstar.net.
¹⁴ Johns Hopkins School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205, USA. Electronic address: mabshir1@jhu.edu.
¹⁵ MedStar Health Institute for Quality and Safety, MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA. Electronic address: Kelly.Smith@tehn.ca.
¹⁶ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: jwolff2@jhu.edu.
¹⁷ MedStar Health, 10980 Granchester Way, Columbia, MD 21044, USA. Electronic address: ryan.anderson@medstar.net.
¹⁸ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: dechava1@jhu.edu.
¹⁹ Johns Hopkins Medicine, 15,627 Clear Spring Rd, Williamsport, MD 21795, USA. Electronic address: tfunkho1@jhmi.edu.
²⁰ Johns Hopkins Medicine Office of Population Health, 750 E Pratt Street 5th floor, Baltimore, MD 21202, USA. Electronic address: knicho25@jhmi.edu.
²¹ Johns Hopkins Community Physicians, Mt. Washington Campus - Marbury Building, 6225 Smith Avenue, Suite B-300, Baltimore, MD 21209-3600, USA. Electronic address: crawlin8@jhmi.edu.
²² MedStar Health, 10,980 Granchester Way, Columbia, MD 21044, USA. Electronic address: sri.ribala@medstar.net.
²³ MedStar Health, 10,980 Grantchester Way, Columbia, MD 21044, USA.
²⁴ Population Health Infrastructure, Johns Hopkins Medical Institutions, 5755 Cedar Ln, Columbia, MD 21044, USA. Electronic address: ltorres6@jhmi.edu.

PMID: 35690262
PMCID: PMC9700199
DOI: 10.1016/j.cct.2022.106818

Abstract

Background: Advance care planning (ACP) and involving family are particularly important in dementia, and primary care is a key setting. The purpose of this trial is to examine the impact and implementation of SHARING Choices, an intervention to improve communication for older adults with and without dementia through proactively supporting ACP and family engagement in primary care.

Methods: We cluster-randomized 55 diverse primary care practices across two health systems to the intervention or usual care. SHARING Choices is a multicomponent intervention that aims to improve communication through patient and family engagement in ACP, agenda setting, and shared access to the patient portal for all patients over 65 years of age. The primary outcomes include documentation of an advance directive or medical orders for life-sustaining treatment in the electronic health record (EHR) at 12 months for all patients and receipt of potentially burdensome care within 6 months of death for the subgroup of patients with serious illness. We plan a priori sub-analysis for patients with dementia. Data sources include the health system EHRs and the Maryland health information exchange. We use a mixed-methods approach to evaluate uptake, fidelity and adaptation of the intervention and implementation facilitators and barriers.

Conclusions: This cluster-randomized pragmatic trial examines ACP with a focus on the key population of those with dementia, implementation in diverse settings and innovative approaches to trial design and outcome abstraction. Mixed-methods approaches enable understanding of intervention delivery and facilitators and barriers to implementation in rapidly changing health care systems.

Clinicaltrials: gov Identifier: NCT04819191.

Keywords: Advance care planning; Advance directives; Dementia; Primary care.

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Conflict of interest statement

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1.**
Content of outreach letter to patients [Johns Hopkins version).

**Fig. 2.**
Agenda-setting checklist (Johns Hopkins version).

See this image and copyright information in PMC

References

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SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care

Collaborators

Affiliations

SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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References

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