Improving primary care clinicians' advance care planning for alzheimer's disease and related dementias - advance care planning (ACP) is the planning that takes place between healthcare team members…

Improving primary care clinicians' advance care planning for alzheimer's disease and related dementias - advance care planning (ACP) is the planning that takes place between healthcare team members and patients prior to the onset of serious illness to ensure a person receives medical care that aligns with their wishes and values. Alzheimer's disease and alzheimer's disease related neurodegenerative dementias (ad/ADRD) are incurable, progressive and terminal diseases with unparalleled impact on the US healthcare system, patients, and families. Over 5 million americans live with ad/ADRD, and people with ad/ADRD lose decision-making capacity years in advance of critical and serious medical illness. Clinicians must discern when and how people with ad/ADRD can express valid treatment preferences at all stages of ad/ADRD. Most people with ad/ADRD are managed by primary care team members who receive little education and training on dementia-specific ACP skills. Primary care teams, including physicians, advance practice providers, nurses and social workers, are well-positioned to empower people living with ad/ADRD (PLWD) and their families in ACP, yet lack critical dementia-specific ACP skills. Evidence-based ACP interventions for PLWD are rare, and no prior clinical trial addresses ad/ADRD ACP in primary care. Our experienced investigative team has demonstrated feasibility and preliminary efficacy of an ad ACP intervention (ad ACP toolkit) for primary care teams. IT includes both a 3- hour dementia-specific education and ACP communication skills training session and subsequent ACP implementation guidance. We will test whether our ad ACP intervention will enable primary care teams to better conduct goals of care (GOC) discussions more efficiently and thus increase the number of GOC discussions held as compared to controls. We will deliver the ad ACP toolkit to 10 intervention primary care clinics and usual care to 10 control clinics using a computerized case-finding algorithm within a large integrated health care system. Our first aim is to conduct a trial comparing the ad ACP toolkit to usual care on GOC discussions and other ACP measures (N=800). The second aim is to examine the 18-month healthcare utilization outcomes for all PLWD with >50% 5-year mortality risk between intervention and control (N=2,660). We will conduct secondary analyses to examine outcomes by key patient and team characteristics. Lastly, we will assess implementation via surveys in the intervention clinics (N=100) followed by interviews (N=60) to explain variations in those outcomes. This project addresses national institute on aging's mission to improve care for older adults with ad/ADRD in primary care. This work will improve how to incorporate ACP approaches for aging-related conditions by primary care teams and may be adaptable to other outpatient specialties such as oncology or cardiology.