Improving Advance Care Planning by Preparing Diverse Seniors for Decision Making

PREPARE is a website (www.prepareforyourcare.org) that teaches patients how to identify what is most important in life, how to communicate their preferences to clinicians and loved ones, and how to make informed decisions. It is written at a 5th grade level and includes voice-overs of text and closed captioning of videos that model advance care planning behaviors. The goal of this proposal is to test the efficacy of PREPARE plus an easy-to-read advance directive, versus an advance directive alone, to improve patient engagement in multiple advance care planning behaviors including discussions with surrogate decision makers and clinicians in addition to advance directive completion. The investigators will also determine whether PREPARE can empower and activate patients within clinical encounters with their clinicians and help to decrease health disparities in advance care planning.

Inclusion criteria

• English-speaking older adults (≥55 years)
• ≥ 2 chronic illnesses determined by International Classification of Diseases-9 (ICD-9) codes
• ≥ 2 visits with an outpatient primary care clinician at San Francisco General Hospital in the past year
• ≥2 additional outpatient/inpatient visits to San Francisco General Hospital in the past year

Exclusion criteria

• deaf, blind, or demented as determined by ICD-9 codes
• too mentally or physically ill to participate as determined by their clinicians
• Moderate or severe cognitive impairment as determined by the Short Portable Mental Status Questionnaire (SPMSQ), and mild cognitive impairment as determined by the SPMSQ plus an abnormal Mini-Cog
• self-reported poor vision and inability to see the words on a newspaper
• lack of a telephone
• traveling or moving out of the area for ≥3 months during the study follow- up period