Group Advanced Care Planning Pilot for Veterans

Documentation of goals of care discussions will be analyzed for each patient at 8 weeks after patient enrollment.

Each patient will receive a validated Heard and Understood assessment survey. 4-item National Quality Forum-endorsed survey assessing self-perceived quality of communication with clinical care team. Each question is scored with a range of 0 to 4, with analyses comparing the proportion of patients reporting a top score (4) for a given question. The measure's reliability and validity has been assessed in a large study of outpatients with serious illness. It will be collected by self-report and self-administered assessment for each patient at Baseline and Week 8.

Each patient will receive a validated patient activation survey (PAM-10) to assess their activation. This is a validated measure from Insignia Health. Responses are: disagree strongly, disagree, agree, agree strongly with higher activation correlated with responses of agree and agree strongly. Each item is rated on 4-point scale (1 strongly disagree to 4 strongly agree, with additional "not applicable" option). Higher scores indicate greater patient activation. It will be collected for each patient by self-assessment at Baseline and Week 8.

Each patient will receive a validated satisfaction with decision survey to assess their satisfaction with decision. It will be analyzed for each patient at Baseline and Week 8.

Palliative care use will be analyzed for each patient at month 6.

Hospice care use will be analyzed at month 6.

Hospital use for each patient will be self-reported by each patient or abstracted by electronic medical record at month 6.