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Randomized Controlled Trial
. 2024 Oct;20(10):7263-7273.
doi: 10.1002/alz.14210. Epub 2024 Aug 27.

Sharing health care wishes among older adults with cognitive impairment in primary care: Results from a randomized controlled trial

Jennifer L Wolff  1 , John G Cagle  2 , Valecia Hanna  3 , Sydney M Dy  3 , Diane Echavarria  4 , Erin R Giovannetti  5 , Cynthia M Boyd  6 , Martha Abshire Saylor  7 , Naaz Hussain  8 , Jenni S Reiff  3 , Danny Scerpella  3 , Talan Zhang  3 , Vishaldeep Kaur Sekhon  9 , David L Roth  9
Affiliations
Randomized Controlled Trial

Sharing health care wishes among older adults with cognitive impairment in primary care: Results from a randomized controlled trial

Jennifer L Wolff et al. Alzheimers Dement. 2024 Oct.

Abstract

Introduction: Best practices for conducting advance care planning (ACP) among persons with cognitive impairment exist, but evidence-based models are lacking for the primary care setting.

Methods: We tested a remote multicomponent ACP model (SHARE) versus minimally enhanced usual care in 273 person-family dyads from eight primary care practices.

Results: Mean patient age was 88.0 years, 85 (31.1%) were Black/Latino; 189 (69.2%) had moderate-to-severe cognitive impairment. Most (101/145; 69.6%) intervention dyads engaged in ACP. At follow-up, no treatment effect was observed for care partner-reported quality of communication about end-of-life care at 6 or 12 months, but intervention patients reported better quality of communication about end-of-life care at 12 months. Intervention care partners and patients reported greater readiness to engage in ACP at 6 and 12 months, respectively, and increased completion of key aspects of ACP.

Discussion: SHARE supported key aspects of ACP processes and communication about end-of-life care.

Highlights: Primary care-based models of ACP for persons with dementia are lacking. Involving persons with cognitive impairment in remote ACP is feasible with care partner involvement. Results indicate benefit for aspects of ACP processes and communication about end-of-life care.

Keywords: advance care planning; cognitive impairment; primary care; randomized controlled trial.

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Conflict of interest statement

The authors declare no competing interests to report. Author disclosures are available in the supporting information.

Figures

FIGURE 1
FIGURE 1
SHARE CONSORT diagram. CONSORT, consolidated standards of reporting trials.
FIGURE 2
FIGURE 2
Proportion of care partners (Upper Panel) and patients (Bottom Panel) reporting completion of key aspects of ACP at 6‐ and 12‐Months by Treatment Group. Whiskers displaying 95% confidence intervals around estimates adjust for severity of patient cognitive impairment based on TICS‐m score at baseline. See Supplemental Appendix 2, Table 4 for details. ACP, advance care planning; TICS‐m, modified telephone interview for cognitive status.
See this image and copyright information in PMC

References

    1. Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM. Monetary costs of dementia in the United States. N Engl J Med. 2013;368(14):1326‐1334. doi:10.1056/NEJMsa1204629 - DOI - PMC - PubMed
    1. deLima Thomas J, Sanchez‐Reilly S, Bernacki R, et al. Advance care planning in cognitively impaired older adults. J Am Geriatr Soc. 2018;66(8):1469‐1474. doi:10.1111/jgs.15471 - DOI - PubMed
    1. van der Steen JT, Nakanishi M, Van den Block L, et al. Consensus definition of advance care planning in dementia: a 33‐country Delphi study. J Alzheimer's Dis. 2023;20(2):1309‐1320. doi:10.1002/alz.13526 - DOI - PMC - PubMed
    1. Fried TR. Giving up on the objective of providing goal‐concordant care: advance care planning for improving caregiver outcomes. J Am Geriatr Soc. 2022;70(10):3006‐3011. doi:10.1111/jgs.18000 - DOI - PMC - PubMed
    1. Wendler D, Rid A. Systematic review: the effect on surrogates of making treatment decisions for others. Ann Intern Med. 2011;154(5):336‐346. doi:10.7326/0003-4819-154-5-201103010-00008 - DOI - PubMed

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