Effect of Emergency Department-Initiated Video-Enhanced Advance Care Planning on Documentation and Goal-Concordant Care: A Randomized Clinical Trial.
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- Record sourced from PubMed, PMID 41998266.
- Also identified by DOI 10.1007/s11606-026-10406-6.
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Abstract
Advance care planning (ACP) is widely promoted; however, it remains unclear if documentation translates to goal-concordant care aligned with patient values. To determine whether emergency department-initiated video-enhanced ACP increases documentation and improves goal-concordant care among decedents. Multicenter, parallel-group randomized trial (2022-2024, follow-up to 2025). Outcome assessors were blinded to assignment. Three emergency departments. Adults aged ≥ 65 or 50-64 with serious illness. Intervention group (a) viewed an ACP video, (b) had an ACP conversation, and (c) triggered electronic health record provider notification. Controls received usual care. 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). 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). 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. Clinicaltrials.gov identifier: NCT04931797 (posted June 1, 2021).