Trial Summary

Nearly 20 million older adults in the United States undergo major elective surgical procedures, yet a small proportion receive advance care planning (ACP). There are few examples of effective integration of ACP into the presurgical phase, despite ACP being included in national quality metrics and society guidelines for surgical care of older adults. Most efforts have focused on improving surgeons' use of ACP, but the barriers are significant, including varying levels of familiarity and comfort with conducting ACP conversations, lack of dedicated time during the presurgical care episode for these often delicate conversations, and lack of appropriate patient-facing ACP tools to help patients and caregivers make complex decisions about surgical treatment. To overcome these barriers, researchers created and tested PREPARE For Your Care (PREPARE), a patient-facing, interactive, online program that prepares people for complex medical decision-making and communication. PREPARE increases ACP engagement and patient and clinician empowerment to discuss ACP, but its use has not been extended to presurgical settings, where time and resources to conduct ACP are limited. The I CAN DO Surgical ACP trial will test 3 strategies of delivering PREPARE to presurgical populations in 3 large healthcare systems. The study will randomly assign patients aged 65 years or older, or with serious illness, who have been referred for major elective surgery to 1 of 3 study arms. Arm 1 will include a letter about ACP, the PREPARE advance directive, and access to the PREPARE website. Arm 2 will include the elements of Arm 1, plus reminder text messages or phone calls. Arm 3 will include the elements of Arms 1 and 2, plus a healthcare navigator to assist with ACP documentation and patient engagement. Using mixed methods, the study team will assess patients’ and surgical care teams’ experience with surgery ACP. In a qualitative component of the trial, the study team will use natural language processing and data mining to evaluate the content of ACP notes and assess their thematic completeness. The study team hypothesizes that incorporating PREPARE into the electronic health record–based presurgical workflow for older adults and adding automated reminders will empower patients and surgical teams to engage in ACP discussions.

NIH Project Information