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J Palliat Med. 2018 Jun;21(6):853-856. doi: 10.1089/jpm.2017.0476. Epub 2018 Feb 20.

Feasibility of a Video-Based Advance Care Planning Website to Facilitate Group Visits among Diverse Adults from a Safety-Net Health System.

Author information

1
1 Division of Hospital Medicine, Department of Medicine, University of California , San Francisco, California.
2
2 VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC) , Denver, Colorado.
3
3 Division of Geriatric Medicine, Department of Medicine, University of Colorado , Aurora, Colorado.
4
4 Caleb G. Clark Potrero Hill Health Center , Department of Public Health, San Francisco, California.
5
5 Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California , San Francisco, California.
6
6 Division of Geriatrics, Department of Medicine, University of California , San Francisco, California.
7
7 San Francisco Veterans Affairs Medical Center , San Francisco, California.

Abstract

BACKGROUND:

Primary care providers in safety-net settings often do not have time to discuss advance care planning (ACP). Group visits (GV) may be an efficient means to provide ACP education.

OBJECTIVES:

To assess the feasibility and impact of a video-based website to facilitate GVs to engage diverse adults in ACP.

DESIGN:

Feasibility pilot among patients who were ≥55 years of age from two primary care clinics in a Northern California safety-net setting. Participants attended two 90-minute GVs and viewed the five steps of the movie version of the PREPARE website ( www.prepareforyourcare.org ) concerning surrogates, values, and discussing wishes in video format. Two clinician facilitators were available to encourage participation.

MEASUREMENTS:

We assessed pre-to-post ACP knowledge, whether participants designated a surrogate or completed an advance directive (AD), and acceptability of GVs and PREPARE materials.

RESULTS:

We conducted two GVs with 22 participants. Mean age was 64 years (±7), 55% were women, 73% nonwhite, and 55% had limited literacy. Knowledge improved about surrogate designation (46% correct pre vs. 85% post, p = 0.01) and discussing decisions with others (59% vs. 90%, p = 0.01). Surrogate designation increased (48% vs. 85%, p = 0.01) and there was a trend toward AD completion (9% vs. 24%, p = 0.21). Participants rated the GVs and PREPARE materials a mean of 8 (±3.1) on a 10-point acceptability scale.

CONCLUSIONS:

Using the PREPARE movie to facilitate ACP GVs for diverse adults in safety net, primary care settings is feasible and shows potential for increasing ACP engagement.

KEYWORDS:

advance care planning; group visits; safety net; videos

PMID:
29461918
PMCID:
PMC6037186
[Available on 2019-06-01]
DOI:
10.1089/jpm.2017.0476
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