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Background <p>Advance care planning (ACP) is widely promoted; however, it remains unclear if documentation translates to goal-concordant care aligned with patient values.</p> Objective <p>To determine whether emergency department-initiated video-enhanced ACP increases documentation and improves goal-concordant care among decedents.</p> Design <p>Multicenter, parallel-group randomized trial (2022–2024, follow-up to 2025). Outcome assessors were blinded to assignment.</p> Setting <p>Three emergency departments.</p> Participants <p>Adults aged ≥ 65 or 50–64 with serious illness.</p> Interventions <p>Intervention group (a) viewed an ACP video, (b) had an ACP conversation, and (c) triggered electronic health record provider notification. Controls received usual care.</p> Main Measures <p>Primary outcome was ACP documentation within 3&#xa0;months. Secondary outcomes included goals-of-care preferences, ACP knowledge (1–5), engagement (1–4), and documentation at 6&#xa0;months. Goal concordance used a 10-point scale (10 = perfect concordance).</p> Key Results <p>598 patients (298 intervention, 300 control; mean age 73.5 ± 8.1&#xa0;years; 53.7% women) were randomized. At 3&#xa0;months, ACP documentation was significantly higher in the intervention group (45.6% [136/298] vs. 31.3% [94/300]; rate difference [RD] = 14.3%, 95% CI 6.6%-22.0%; <i>P</i> &lt; .001), persisting at 6&#xa0;months (52.3% vs. 39.3%; RD = 13.0%, 95% CI 5.1%-20.9%; <i>P</i> = .002). ACP knowledge (4.1 vs. 3.1; mean difference [MD] = 1.0, 95% CI 0.9–1.2; P &lt; .001) and engagement (4.1 vs. 3.9; MD = 0.2, 95% CI 0.1–0.3; <i>P</i> = .004) were greater in the intervention group compared to the control. There were no differences in goals-of-care preferences between the two study arms. Among 94 decedents (53 intervention, 41 control), intervention recipients had substantially higher goal-concordance scores (median 10 [IQR 8–10] vs. 7 [IQR 3–10]; <i>P</i> &lt; .001).</p> Conclusions <p>Video-enhanced ACP increased documentation rates. Among decedents, goal-concordance was higher in the intervention group, suggesting ED-initiated ACP may help align care with patient preferences.</p> Trial Registration <p>Clinicaltrials.gov identifier: NCT04931797 (posted June 1, 2021).</p>

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Effect of Emergency Department-Initiated Video-Enhanced Advance Care Planning on Documentation and Goal-Concordant Care: A Randomized Clinical Trial

  • 期刊论文

  • 发表日期：

    2026年4月17日

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  • Angelo E. Volandes,
  • Hacho Bohossian,
  • Yuchiao Chang,
  • Charlotta Lindvall,
  • Michael K. Paasche-Orlow,
  • Seth Randa,
  • Upeka Samarakoon,
  • Tadayuki Hashimoto,
  • Nanako Shirai,
  • Aretha D. Davis,
  • Nathan E. Goldstein,
  • Cynthia Garde,
  • Gabriel A. Paasche-Orlow,
  • Kate Sciacca,
  • Karina Klein,
  • Eric Hanson,
  • Allyson Sage,
  • Donovan S. Nielsen,
  • Beth Walker-Corkery,
  • Areej El-Jawahri,
  • Michael J. Barry,
  • Milton Joel,
  • Timothy Platts-Mills,
  • Brigitte N. Durieux,
  • Anne Kwok,
  • Katren R. Tyler,
  • Kei Ouchi

摘要

Background

Advance care planning (ACP) is widely promoted; however, it remains unclear if documentation translates to goal-concordant care aligned with patient values.

Objective

To determine whether emergency department-initiated video-enhanced ACP increases documentation and improves goal-concordant care among decedents.

Design

Multicenter, parallel-group randomized trial (2022–2024, follow-up to 2025). Outcome assessors were blinded to assignment.

Setting

Three emergency departments.

Participants

Adults aged ≥ 65 or 50–64 with serious illness.

Interventions

Intervention group (a) viewed an ACP video, (b) had an ACP conversation, and (c) triggered electronic health record provider notification. Controls received usual care.

Main Measures

Primary outcome was ACP documentation within 3 months. Secondary outcomes included goals-of-care preferences, ACP knowledge (1–5), engagement (1–4), and documentation at 6 months. Goal concordance used a 10-point scale (10 = perfect concordance).

Key Results

598 patients (298 intervention, 300 control; mean age 73.5 ± 8.1 years; 53.7% women) were randomized. At 3 months, ACP documentation was significantly higher in the intervention group (45.6% [136/298] vs. 31.3% [94/300]; rate difference [RD] = 14.3%, 95% CI 6.6%-22.0%; P < .001), persisting at 6 months (52.3% vs. 39.3%; RD = 13.0%, 95% CI 5.1%-20.9%; P = .002). ACP knowledge (4.1 vs. 3.1; mean difference [MD] = 1.0, 95% CI 0.9–1.2; P < .001) and engagement (4.1 vs. 3.9; MD = 0.2, 95% CI 0.1–0.3; P = .004) were greater in the intervention group compared to the control. There were no differences in goals-of-care preferences between the two study arms. Among 94 decedents (53 intervention, 41 control), intervention recipients had substantially higher goal-concordance scores (median 10 [IQR 8–10] vs. 7 [IQR 3–10]; P < .001).

Conclusions

Video-enhanced ACP increased documentation rates. Among decedents, goal-concordance was higher in the intervention group, suggesting ED-initiated ACP may help align care with patient preferences.

Trial Registration

Clinicaltrials.gov identifier: NCT04931797 (posted June 1, 2021).