Trial Outcomes & Findings for Improving Communication About Serious Illness (NCT NCT01933789)

NCT ID: NCT01933789

Last Updated: 2019-03-20

Results Overview

Patient's response to question, "Did you discuss with this doctor the kind of medical care you would want if you were too sick to speak for yourself?"

Recruitment status

COMPLETED

Study phase

Target enrollment

817 participants

Primary outcome timeframe

2 weeks after target visit

Results posted on

2019-03-20

Participant Flow

CLINICIANS and INTERPROFESSIONAL (IP) TEAM recruited from Feb 2014 to Nov 2015. PATIENTS and FAMILY recruited from Mar 2014 to Jun 2016. Potential subjects received introductory letters and phone calls to assess interest and eligibility. INTERVIEWEES were selected via purposive sampling from those who completed the intervention activities.

635 CLINICIANS assessed for eligibility; 503 excluded; 132 enrolled. Unit of randomization was clinician. 11 IP TEAM members identified; 4 enrolled. 1113 PATIENTS assessed for eligibility; 576 excluded; 537 enrolled. 142 FAMILY identified; 23 excluded; 119 enrolled. Subjects were enrolled if they completed a baseline survey prior to target visit.

Participant milestones

Participant milestones
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention Received "Jumpstart" feedback forms and education	Patient Control Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Overall Study STARTED	65	67	2	2	249	288	58	61	25
Overall Study Had Target Visit	61	65	2	2	228	266	0	0	0
Overall Study Completed After-visit Survey	57	64	2	1	0	0	0	0	0
Overall Study Completed 2-Week Survey	0	0	0	0	184	215	0	0	0
Overall Study Completed 3-Month Survey	0	0	0	0	176	211	37	43	0
Overall Study Completed 6-Month Survey	0	0	0	0	160	188	35	40	0
Overall Study Qualitative Interviews	0	0	0	0	0	0	0	0	25
Overall Study COMPLETED	59	66	2	1	190	221	43	47	25
Overall Study NOT COMPLETED	6	1	0	1	59	67	15	14	0

Reasons for withdrawal

Reasons for withdrawal
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Control Received/Provided usual care, surveys only	Patient Intervention Received "Jumpstart" feedback forms and education	Patient Control Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only
Overall Study Death	0	0	0	21	32	0	0
Overall Study Lost to Follow-up	0	0	1	8	9	1	4
Overall Study Withdrawal by Subject	2	1	0	17	16	1	4
Overall Study Became Ineligible	4	0	0	13	10	13	6

Baseline Characteristics

Reporting on Clinician subjects only.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Clinician Intervention n=65 Participants Received "Jumpstart" feedback forms and education	Clinician Control n=67 Participants Received/Provided usual care, surveys only	IP Team Intervention n=2 Participants Received "Jumpstart" feedback forms and education	IP Team Control n=2 Participants Received/Provided usual care, surveys only	Patient Intervention n=249 Participants Received "Jumpstart" feedback forms and education	Patient Control n=288 Participants Received usual care, surveys only	Family Member Intervention n=58 Participants Received "Jumpstart" feedback forms and education	Family Member Control n=61 Participants Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members. These subjects did not complete baseline measures.	Total n=792 Participants Total of all reporting groups
Age, Categorical <=18 years	0 Participants n=65 Participants	0 Participants n=67 Participants	0 Participants n=2 Participants	0 Participants n=2 Participants	0 Participants n=249 Participants	0 Participants n=288 Participants	0 Participants n=58 Participants	0 Participants n=61 Participants	—	0 Participants n=792 Participants
Age, Categorical Between 18 and 65 years	65 Participants n=65 Participants	65 Participants n=67 Participants	2 Participants n=2 Participants	2 Participants n=2 Participants	60 Participants n=249 Participants	76 Participants n=288 Participants	28 Participants n=58 Participants	27 Participants n=61 Participants	—	325 Participants n=792 Participants
Age, Categorical >=65 years	0 Participants n=65 Participants	2 Participants n=67 Participants	0 Participants n=2 Participants	0 Participants n=2 Participants	189 Participants n=249 Participants	212 Participants n=288 Participants	30 Participants n=58 Participants	34 Participants n=61 Participants	—	467 Participants n=792 Participants
Age, Continuous	46.9 years STANDARD_DEVIATION 8.64 • n=65 Participants	47.2 years STANDARD_DEVIATION 10.48 • n=67 Participants	41.0 years STANDARD_DEVIATION 2.83 • n=2 Participants	59.0 years STANDARD_DEVIATION 5.66 • n=2 Participants	73.6 years STANDARD_DEVIATION 11.37 • n=249 Participants	73.3 years STANDARD_DEVIATION 13.71 • n=288 Participants	65.4 years STANDARD_DEVIATION 13.32 • n=58 Participants	65.3 years STANDARD_DEVIATION 13.96 • n=61 Participants	—	67.7 years STANDARD_DEVIATION 15.73 • n=792 Participants
Sex: Female, Male Female	37 Participants n=65 Participants	34 Participants n=67 Participants	2 Participants n=2 Participants	2 Participants n=2 Participants	124 Participants n=249 Participants	132 Participants n=288 Participants	46 Participants n=58 Participants	43 Participants n=61 Participants	—	420 Participants n=792 Participants
Sex: Female, Male Male	28 Participants n=65 Participants	33 Participants n=67 Participants	0 Participants n=2 Participants	0 Participants n=2 Participants	125 Participants n=249 Participants	156 Participants n=288 Participants	12 Participants n=58 Participants	18 Participants n=61 Participants	—	372 Participants n=792 Participants
Race/Ethnicity, Customized White Non-Hispanic	49 Participants n=65 Participants	51 Participants n=67 Participants	2 Participants n=2 Participants	2 Participants n=2 Participants	206 Participants n=249 Participants	219 Participants n=288 Participants	49 Participants n=58 Participants	51 Participants n=61 Participants	—	629 Participants n=792 Participants
Race/Ethnicity, Customized Minority Race/Ethnicity	16 Participants n=65 Participants	16 Participants n=67 Participants	0 Participants n=2 Participants	0 Participants n=2 Participants	43 Participants n=249 Participants	69 Participants n=288 Participants	9 Participants n=58 Participants	8 Participants n=61 Participants	—	161 Participants n=792 Participants
Race/Ethnicity, Customized Unknown or Not Reported	0 Participants n=65 Participants	0 Participants n=67 Participants	0 Participants n=2 Participants	0 Participants n=2 Participants	0 Participants n=249 Participants	0 Participants n=288 Participants	0 Participants n=58 Participants	2 Participants n=61 Participants	—	2 Participants n=792 Participants
Clinician Type Physician	60 Participants n=65 Participants • Reporting on Clinician subjects only.	62 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	122 Participants n=132 Participants • Reporting on Clinician subjects only.
Clinician Type Nurse Practicioner	5 Participants n=65 Participants • Reporting on Clinician subjects only.	5 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	10 Participants n=132 Participants • Reporting on Clinician subjects only.
Clinician's Specialty Family Medicine	14 Participants n=65 Participants • Reporting on Clinician subjects only.	17 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	31 Participants n=132 Participants • Reporting on Clinician subjects only.
Clinician's Specialty Internal Medicine	18 Participants n=65 Participants • Reporting on Clinician subjects only.	18 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	36 Participants n=132 Participants • Reporting on Clinician subjects only.
Clinician's Specialty Oncology	8 Participants n=65 Participants • Reporting on Clinician subjects only.	18 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	26 Participants n=132 Participants • Reporting on Clinician subjects only.
Clinician's Specialty Pulmonology	3 Participants n=65 Participants • Reporting on Clinician subjects only.	5 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	8 Participants n=132 Participants • Reporting on Clinician subjects only.
Clinician's Specialty Cardiology	14 Participants n=65 Participants • Reporting on Clinician subjects only.	3 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	17 Participants n=132 Participants • Reporting on Clinician subjects only.
Clinician's Specialty Gastroenterology	3 Participants n=65 Participants • Reporting on Clinician subjects only.	1 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	4 Participants n=132 Participants • Reporting on Clinician subjects only.
Clinician's Specialty Nephrology	3 Participants n=65 Participants • Reporting on Clinician subjects only.	4 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	7 Participants n=132 Participants • Reporting on Clinician subjects only.
Clinician's Specialty Geriatrics	2 Participants n=65 Participants • Reporting on Clinician subjects only.	1 Participants n=67 Participants • Reporting on Clinician subjects only.	—	—	—	—	—	—	—	3 Participants n=132 Participants • Reporting on Clinician subjects only.
Competence [Communication & End-of-Life (EOL) Care]	3.8 units on a scale STANDARD_DEVIATION 0.55 • n=64 Participants • Questionnaire asked of clinicians at baseline. One intervention clinician did not return a baseline survey.	3.5 units on a scale STANDARD_DEVIATION 0.57 • n=67 Participants • Questionnaire asked of clinicians at baseline. One intervention clinician did not return a baseline survey.	—	—	—	—	—	—	—	3.8 units on a scale STANDARD_DEVIATION 0.56 • n=131 Participants • Questionnaire asked of clinicians at baseline. One intervention clinician did not return a baseline survey.
Patient Self-Assessed Health Status	—	—	—	—	2 units on a scale n=247 Participants • Survey item asked of patients at baseline. Two intervention patients did not provide a valid response.	2 units on a scale n=288 Participants • Survey item asked of patients at baseline. Two intervention patients did not provide a valid response.	—	—	—	2 units on a scale n=535 Participants • Survey item asked of patients at baseline. Two intervention patients did not provide a valid response.
Patient Education Level	—	—	—	—	3 units on a scale n=248 Participants • Survey item asked of patients at baseline. One intervention patient did not provide a valid response.	3 units on a scale n=288 Participants • Survey item asked of patients at baseline. One intervention patient did not provide a valid response.	—	—	—	3 units on a scale n=536 Participants • Survey item asked of patients at baseline. One intervention patient did not provide a valid response.
Patient Average Monthly Income	—	—	—	—	5 units on a scale n=230 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide a valid response.	5 units on a scale n=270 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide a valid response.	—	—	—	5 units on a scale n=500 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide a valid response.
Preference Regarding Future Discussion with Clinician No objection to future discussion stated	—	—	—	—	197 Participants n=249 Participants • Based on survey items asked of patients at baseline.	212 Participants n=288 Participants • Based on survey items asked of patients at baseline.	—	—	—	409 Participants n=537 Participants • Based on survey items asked of patients at baseline.
Preference Regarding Future Discussion with Clinician Objected to future discussion	—	—	—	—	52 Participants n=249 Participants • Based on survey items asked of patients at baseline.	76 Participants n=288 Participants • Based on survey items asked of patients at baseline.	—	—	—	128 Participants n=537 Participants • Based on survey items asked of patients at baseline.
Quality of Communication (QOC): Four-Indicator Latent Construct	—	—	—	—	-0.695 scores on a scale STANDARD_DEVIATION 7.089 • n=127 Participants • All 4 items answered at baseline \& 2 weeks: 127 valid intervention responses; 141 valid control responses. Unit of measure: continuous measure with control group mean fixed at zero.	0.000 scores on a scale STANDARD_DEVIATION 6.332 • n=141 Participants • All 4 items answered at baseline \& 2 weeks: 127 valid intervention responses; 141 valid control responses. Unit of measure: continuous measure with control group mean fixed at zero.	—	—	—	-0.329 scores on a scale STANDARD_DEVIATION 6.698 • n=268 Participants • All 4 items answered at baseline \& 2 weeks: 127 valid intervention responses; 141 valid control responses. Unit of measure: continuous measure with control group mean fixed at zero.
Quality of Communication (QOC): Individual QOC Items Discuss feelings about getting sicker	—	—	—	—	5.5 units on a scale n=230 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	8 units on a scale n=267 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	—	—	—	6 units on a scale n=497 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.
Quality of Communication (QOC): Individual QOC Items Discuss details about getting sicker	—	—	—	—	7 units on a scale n=235 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	8 units on a scale n=266 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	—	—	—	7 units on a scale n=501 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.
Quality of Communication (QOC): Individual QOC Items Discuss prognosis	—	—	—	—	0 units on a scale n=235 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	0 units on a scale n=273 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	—	—	—	0 units on a scale n=508 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.
Quality of Communication (QOC): Individual QOC Items Discuss what dying might be like	—	—	—	—	0 units on a scale n=239 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	0 units on a scale n=278 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	—	—	—	0 units on a scale n=517 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.
Quality of Communication (QOC): Individual QOC Items Involve in EOL treatment decisions	—	—	—	—	0 units on a scale n=235 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	0 units on a scale n=277 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	—	—	—	0 units on a scale n=512 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.
Quality of Communication (QOC): Individual QOC Items Ask about important things in life	—	—	—	—	5 units on a scale n=237 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	8 units on a scale n=272 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	—	—	—	6 units on a scale n=509 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.
Quality of Communication (QOC): Individual QOC Items Ask about spiritual or religious beliefs	—	—	—	—	0 units on a scale n=236 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	0 units on a scale n=271 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.	—	—	—	0 units on a scale n=507 Participants • Survey item asked of patients at baseline. Some intervention and control patients did not provide valid responses on all items.
Patient Health Questionnaire (PHQ-8): Two-Indicator Latent Construct	—	—	—	—	0.327 scores on a scale STANDARD_DEVIATION 0.706 • n=117 Participants • Both items answered at baseline, 3-months \& 6-months: 117 valid intervention responses; 145 valid control responses. Unit of measure: continuous measure with control group mean fixed at zero.	0.000 scores on a scale STANDARD_DEVIATION 0.743 • n=145 Participants • Both items answered at baseline, 3-months \& 6-months: 117 valid intervention responses; 145 valid control responses. Unit of measure: continuous measure with control group mean fixed at zero.	—	—	—	0.146 scores on a scale STANDARD_DEVIATION 0.743 • n=262 Participants • Both items answered at baseline, 3-months \& 6-months: 117 valid intervention responses; 145 valid control responses. Unit of measure: continuous measure with control group mean fixed at zero.
Patient Health Questionnaire (PHQ-8): Eight-Item Scale	—	—	—	—	5.859 scores on a scale STANDARD_DEVIATION 4.796 • n=245 Participants • Survey items asked of patients at baseline. Some intervention and control patients did not provide valid responses on 7+ items.	5.152 scores on a scale STANDARD_DEVIATION 4.744 • n=286 Participants • Survey items asked of patients at baseline. Some intervention and control patients did not provide valid responses on 7+ items.	—	—	—	5.478 scores on a scale STANDARD_DEVIATION 4.777 • n=531 Participants • Survey items asked of patients at baseline. Some intervention and control patients did not provide valid responses on 7+ items.
Generalized Anxiety Disorder (GAD-7): Two-Indicator Latent Construct	—	—	—	—	0.179 scores on a scale STANDARD_DEVIATION 0.901 • n=127 Participants • Both items answered at baseline, 3-months \& 6-months: 127 valid intervention responses; 150 valid control responses. Unit of measure: continuous measure with control group mean fixed at zero.	0.000 scores on a scale STANDARD_DEVIATION 0.899 • n=150 Participants • Both items answered at baseline, 3-months \& 6-months: 127 valid intervention responses; 150 valid control responses. Unit of measure: continuous measure with control group mean fixed at zero.	—	—	—	0.082 scores on a scale STANDARD_DEVIATION 0.903 • n=277 Participants • Both items answered at baseline, 3-months \& 6-months: 127 valid intervention responses; 150 valid control responses. Unit of measure: continuous measure with control group mean fixed at zero.
Generalized Anxiety Disorder (GAD-7): Seven-Item Scale	—	—	—	—	2 scores on a scale n=247 Participants • Survey items asked of patients at baseline. Some intervention and control patients did not provide valid responses on 6+ items.	1 scores on a scale n=287 Participants • Survey items asked of patients at baseline. Some intervention and control patients did not provide valid responses on 6+ items.	—	—	—	2 scores on a scale n=534 Participants • Survey items asked of patients at baseline. Some intervention and control patients did not provide valid responses on 6+ items.
Choosing Care Extending life	—	—	—	—	46 Participants n=249 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	43 Participants n=286 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	12 Participants n=58 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	11 Participants n=59 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	—	112 Participants n=652 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.
Choosing Care Quality of life (relieving pain and discomfort)	—	—	—	—	149 Participants n=249 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	174 Participants n=286 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	32 Participants n=58 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	38 Participants n=59 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	—	393 Participants n=652 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.
Choosing Care I don't know/Not sure	—	—	—	—	54 Participants n=249 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	69 Participants n=286 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	14 Participants n=58 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	10 Participants n=59 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.	—	147 Participants n=652 Participants • Survey items asked of patients \& family members at baseline. Two control patients and two control family members did not answer this item.
Focus of Care Extending life	—	—	—	—	84 Participants n=244 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	113 Participants n=284 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	19 Participants n=57 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	20 Participants n=59 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	—	236 Participants n=644 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.
Focus of Care Quality of life (relieving pain and discomfort)	—	—	—	—	84 Participants n=244 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	90 Participants n=284 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	20 Participants n=57 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	24 Participants n=59 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	—	218 Participants n=644 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.
Focus of Care I don't know/Not sure	—	—	—	—	76 Participants n=244 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	81 Participants n=284 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	18 Participants n=57 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	15 Participants n=59 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.	—	190 Participants n=644 Participants • Survey items asked of patients \& family members at baseline. Nine patients \[5 intervention and 4 control\] and three family members \[1 intervention and 2 control\] did not answer this item.
Barriers I don't know what kind of care I would want	—	—	—	—	101 Participants n=241 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	114 Participants n=286 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	215 Participants n=527 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Barriers I'm not ready to talk about care I would want	—	—	—	—	55 Participants n=245 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	55 Participants n=287 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	110 Participants n=532 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Barriers I don't like to talk about getting very sick	—	—	—	—	69 Participants n=243 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	79 Participants n=288 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	148 Participants n=531 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Barriers My doctor never seems to have the time	—	—	—	—	18 Participants n=237 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	25 Participants n=282 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	43 Participants n=519 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Barriers I'd rather concentrate on staying alive	—	—	—	—	145 Participants n=242 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	169 Participants n=285 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	314 Participants n=527 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Barriers I feel that talking about death can bring it close	—	—	—	—	29 Participants n=241 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	37 Participants n=283 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	66 Participants n=524 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Barriers I have a living will, so I don't need to talk	—	—	—	—	51 Participants n=245 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	73 Participants n=283 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	124 Participants n=528 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Barriers My ideas about the kind of care I want change	—	—	—	—	107 Participants n=243 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	110 Participants n=285 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	217 Participants n=528 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Barriers I have not felt sick enough	—	—	—	—	132 Participants n=244 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	146 Participants n=284 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	278 Participants n=528 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Barriers I'm not sure which doctor would be caring for me	—	—	—	—	126 Participants n=242 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	136 Participants n=283 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.	—	—	—	262 Participants n=525 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of barrier item. Not all patients answered all items.
Facilitators I have been very sick	—	—	—	—	130 Participants n=243 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.	145 Participants n=284 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.	—	—	—	275 Participants n=527 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.
Facilitators I have had family or friends who have died	—	—	—	—	161 Participants n=240 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.	200 Participants n=285 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.	—	—	—	361 Participants n=525 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.
Facilitators I worry about the quality of my life in the future	—	—	—	—	132 Participants n=245 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.	151 Participants n=285 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.	—	—	—	283 Participants n=530 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.
Facilitators I worry that I could be a burden	—	—	—	—	171 Participants n=245 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.	190 Participants n=285 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.	—	—	—	361 Participants n=530 Participants • Survey items asked of patients at baseline. Row values indicate endorsement ("applies to me") of facilitator item. Not all patients answered all items.

PRIMARY outcome

Timeframe: 2 weeks after target visit

Population: Patients completing 2-week questionnaires. Not all patients provided data at this time point.

Patient's response to question, "Did you discuss with this doctor the kind of medical care you would want if you were too sick to speak for yourself?"

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=184 Participants Received "Jumpstart" feedback forms and education	Patient Control n=215 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Occurrence of Discussion About Goals of Care at Target Visit Yes	—	—	—	—	137 Participants	66 Participants	—	—	—
Occurrence of Discussion About Goals of Care at Target Visit No or Don't Know	—	—	—	—	47 Participants	145 Participants	—	—	—
Occurrence of Discussion About Goals of Care at Target Visit No response	—	—	—	—	0 Participants	4 Participants	—	—	—

SECONDARY outcome

Timeframe: Target visit

Population: Target visit abstracted from patient electronic health record (EHR); not all data were available for this time point.

Electronic Health Record (EHR) documentation of discussion about advance care planning, prognosis, treatment preference, hospice, palliative care, or Physician Orders for Life-Sustaining Treatment (POLST) at target visit

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=227 Participants Received "Jumpstart" feedback forms and education	Patient Control n=265 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Occurrence of Discussion About Goals of Care at Target Visit Discussion documented	—	—	—	—	140 Participants	45 Participants	—	—	—
Occurrence of Discussion About Goals of Care at Target Visit Discussion not documented	—	—	—	—	87 Participants	220 Participants	—	—	—

SECONDARY outcome

Timeframe: 2 weeks after target visit

Population: Patients who completed 2-week questionnaires and reported no objection at baseline.

Patient's response to question, "Did you discuss with this doctor the kind of medical care you would want if you were too sick to speak for yourself?"

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=143 Participants Received "Jumpstart" feedback forms and education	Patient Control n=164 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Occurrence of Discussion About Goals of Care at Target Visit Among Patients Who Did Not Object to Future Discussion at Baseline Yes	—	—	—	—	112 Participants	44 Participants	—	—	—
Occurrence of Discussion About Goals of Care at Target Visit Among Patients Who Did Not Object to Future Discussion at Baseline No or Don't know	—	—	—	—	31 Participants	116 Participants	—	—	—
Occurrence of Discussion About Goals of Care at Target Visit Among Patients Who Did Not Object to Future Discussion at Baseline No response	—	—	—	—	0 Participants	4 Participants	—	—	—

SECONDARY outcome

Timeframe: Target visit

Population: Patient EHR abstracted for target visit and had no objection at baseline.

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=180 Participants Received "Jumpstart" feedback forms and education	Patient Control n=199 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Occurrence of Discussion About Goals of Care at Target Visit Among Patients Who Did Not Object to Future Discussion at Baseline Discussion documented	—	—	—	—	114 Participants	34 Participants	—	—	—
Occurrence of Discussion About Goals of Care at Target Visit Among Patients Who Did Not Object to Future Discussion at Baseline Discussion not documented	—	—	—	—	66 Participants	165 Participants	—	—	—

SECONDARY outcome

Timeframe: 3 months after target visit

Population: Survey items asked of patients at 3-months. Not all patients provided data at this time point.

Binary variable indicating whether patient's reported focus of current treatment was concordant with treatment preference

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=176 Participants Received "Jumpstart" feedback forms and education	Patient Control n=211 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Goal-Concordant Care Discordant	—	—	—	—	74 Participants	116 Participants	—	—	—
Goal-Concordant Care Concordant	—	—	—	—	93 Participants	84 Participants	—	—	—
Goal-Concordant Care Unknown (no resp to preference &/or current care)	—	—	—	—	9 Participants	11 Participants	—	—	—

SECONDARY outcome

Timeframe: 3 months after target visit

Population: Survey items asked of patients at 3-months. Not all patients provided data at this time point.

Binary variable indicating whether patient's reported focus of current treatment was concordant with treatment preference

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=104 Participants Received "Jumpstart" feedback forms and education	Patient Control n=103 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Goal-Concordant Care Among Patients With Stable Treatment Preference Concordant	—	—	—	—	74 Participants	57 Participants	—	—	—
Goal-Concordant Care Among Patients With Stable Treatment Preference Discordant	—	—	—	—	27 Participants	43 Participants	—	—	—
Goal-Concordant Care Among Patients With Stable Treatment Preference Unknown (no resp to preference &/or current care)	—	—	—	—	3 Participants	3 Participants	—	—	—

SECONDARY outcome

Timeframe: 2 weeks from target visit

Population: All 4 items asked of patients at baseline \& 2 weeks. Not all patients provided data at these time points. Continuous measure with control group mean fixed at zero at baseline.

Quality of Communication: patient ratings of clinician on seven aspects of end-of-life communication, each aspect having a pseudo-continuous response range of 0 ('clinician didn't do this') to 11 ('the very best I could imagine'). Measured with QOC items 1, 2, 5, \& 6 (measurement invariance imposed between groups and over time). Outcome is a latent variable, which is not observable, nor is it a composite score that can be mathematically computed (e.g., as a sum or average) from its measured indicators. Instead, it is an abstract construct that is inferred through a mathematical model; it represents a concept and is, therefore, a hypothetical variable. Theoretical range: unknown; the latent variable is a hypothetical - not an actual - variable Actual range: inapplicable; cannot be determined; this is an indirectly-measured latent variable; Higher value indicates better outcome (i.e., higher quality communication) Unit of measurement: scores on a scale

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=127 Participants Received "Jumpstart" feedback forms and education	Patient Control n=141 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Quality of Communication (QOC): Four-Indicator Latent Construct	—	—	—	—	4.585 scores on a scale Standard Deviation 4.208	2.128 scores on a scale Standard Deviation 5.570	—	—	—

SECONDARY outcome

Timeframe: 2 weeks from target visit

Population: Survey items asked of patients at 2-weeks. Not all patients provided data at this time point.

Quality of Communication: patient ratings of clinician on seven aspects of end-of-life communication, each aspect having a pseudo-continuous response range of 0 ('clinician didn't do this') to 11 ('the very best I could imagine'). Individual QOC Items. Theoretical range: 0-11 Actual range: 0-11 Higher value indicates better outcome (i.e., higher quality communication) Unit of measurement: units on a scale

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=249 Participants Received "Jumpstart" feedback forms and education	Patient Control n=288 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Quality of Communication (QOC): Individual QOC Items Discuss feelings about getting sicker	—	—	—	—	10 units on a scale Interval 6.5 to 11.0	8 units on a scale Interval 0.0 to 11.0	—	—	—
Quality of Communication (QOC): Individual QOC Items Discuss details about getting sicker	—	—	—	—	9 units on a scale Interval 0.0 to 11.0	8 units on a scale Interval 0.0 to 11.0	—	—	—
Quality of Communication (QOC): Individual QOC Items Discuss prognosis	—	—	—	—	0 units on a scale Interval 0.0 to 9.0	0 units on a scale Interval 0.0 to 9.0	—	—	—
Quality of Communication (QOC): Individual QOC Items Discuss what dying might be like	—	—	—	—	0 units on a scale Interval 0.0 to 1.0	0 units on a scale Interval 0.0 to 0.0	—	—	—
Quality of Communication (QOC): Individual QOC Items Involve in EOL treatment decisions	—	—	—	—	9 units on a scale Interval 0.0 to 11.0	0 units on a scale Interval 0.0 to 10.0	—	—	—
Quality of Communication (QOC): Individual QOC Items Ask about important things in life	—	—	—	—	9 units on a scale Interval 0.0 to 11.0	8 units on a scale Interval 0.0 to 11.0	—	—	—
Quality of Communication (QOC): Individual QOC Items Ask about spiritual or religion beliefs	—	—	—	—	0 units on a scale Interval 0.0 to 9.0	0 units on a scale Interval 0.0 to 4.5	—	—	—

SECONDARY outcome

Timeframe: 3 months after target visit

Population: Both survey items answered by patients at baseline, 3-months \& 6-months: 117 valid intervention responses; 145 valid control responses. Continuous measure with control group mean fixed at zero.

Patient Health Questionnaire: A self-report measure of depressive symptoms. Eight symptoms, each with ordinal response options, each option associated with a text description ranging from 'Not at all' to 'Nearly every day'. Two-Indicator Latent Construct: Measured with PHQ items 1 \& 2 (measurement invariance imposed between groups and over time). Outcome is a latent variable, which is not observable, nor is it a composite score that can be mathematically computed (e.g., as a sum or average) from its measured indicators. Instead, it is an abstract construct that is inferred through a mathematical model; it represents a concept and is, therefore, a hypothetical variable. Theoretical range: unknown; the latent variable is a hypothetical - not an actual - variable Actual range: inapplicable; cannot be determined; this is an indirectly-measured latent variable Higher value indicates worse outcome (i.e., higher level of depressive symptoms) Unit of measurement: scores on a scale

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=117 Participants Received "Jumpstart" feedback forms and education	Patient Control n=145 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Patient Health Questionnaire (PHQ-8): Two-Indicator Latent Construct	—	—	—	—	0.255 scores on a scale Standard Deviation 0.804	0.199 scores on a scale Standard Deviation 0.722	—	—	—

SECONDARY outcome

Timeframe: 3 months after target visit

Population: Survey items asked of patients at baseline. Some intervention and control patients did not provide valid responses on 7+ items.

Patient Health Questionnaire: A self-report measure of depressive symptoms. Eight symptoms, each with ordinal response options, each option associated with a text description ranging from 'Not at all' to 'Nearly every day'. Eight-Item Scale: Sum of responses for the eight symptoms (weighted by 8/7 if only 7 items answered). Theoretical range: 0-24 Actual range: 0-24 Higher value indicates worse outcome (i.e., higher level of depressive symptoms) Unit of measurement: scores on a scale

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=167 Participants Received "Jumpstart" feedback forms and education	Patient Control n=195 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Patient Health Questionnaire (PHQ-8): Eight-Item Scale	—	—	—	—	5.879 scores on a scale Standard Deviation 4.776	4.908 scores on a scale Standard Deviation 4.634	—	—	—

SECONDARY outcome

Timeframe: 6 months after target visit

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=117 Participants Received "Jumpstart" feedback forms and education	Patient Control n=145 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Patient Health Questionnaire (PHQ-8): Two-Indicator Latent Construct	—	—	—	—	0.399 scores on a scale Standard Deviation 0.873	0.244 scores on a scale Standard Deviation 0.737	—	—	—

SECONDARY outcome

Timeframe: 6 months after target visit

Population: Survey items asked of patients at 6-months. Some intervention and control patients did not provide valid responses on 7+ items.

Patient Health Questionnaire: A self-report measure of depressive symptoms. Eight symptoms, each with ordinal response options, each option associated with a text description ranging from 'Not at all' to 'Nearly every day'. Eight-Item Scale: Sum of responses for the eight symptoms (weighted by 8/7 if only 7 items answered). Theoretical range: 0-24 Actual range: 0-24 Higher value indicates worse outcome (i.e., higher level of depressive symptoms) Unit of measurement: scores on a scale

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=146 Participants Received "Jumpstart" feedback forms and education	Patient Control n=171 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Patient Health Questionnaire (PHQ-8): Eight-Item Scale	—	—	—	—	5.853 scores on a scale Standard Deviation 5.339	4.850 scores on a scale Standard Deviation 4.410	—	—	—

SECONDARY outcome

Timeframe: 3 months after target visit

Population: Both survey items answered by patients at baseline, 3-months \& 6-months: 127 valid intervention responses; 150 valid control responses. Continuous measure with control group mean fixed at zero at baseline.

Generalized Anxiety Disorder: A self-report measure of anxiety symptoms. Seven symptoms, each with ordinal response options, each option associated with a text description ranging from 'Not at all' to 'Nearly every day'. Two-Indicator Latent Construct: Measured with GAD items 1 \& 2 (measurement invariance imposed between groups and over time). Outcome is a latent variable, which is not observable, nor is it a composite score that can be mathematically computed (e.g., as a sum or average) from its measured indicators. Instead, it is an abstract construct that is inferred through a mathematical model; it represents a concept and is, therefore, a hypothetical variable. Theoretical range: unknown; the latent variable is a hypothetical - not an actual - variable Actual range: inapplicable; cannot be determined; this is an indirectly-measured latent variable Higher value indicates worse outcome (i.e., higher level of anxiety symptoms) Unit of measurement: scores on a scale

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=127 Participants Received "Jumpstart" feedback forms and education	Patient Control n=150 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Generalized Anxiety Disorder (GAD-7): Two-Indicator Latent Construct	—	—	—	—	0.281 scores on a scale Standard Deviation 0.788	0.217 scores on a scale Standard Deviation 0.807	—	—	—

SECONDARY outcome

Timeframe: 3 months after target visit

Population: Survey items asked of patients at 3-months. Some intervention and control patients did not provide valid responses on 6+ items.

Generalized Anxiety Disorder: A self-report measure of anxiety symptoms. Seven symptoms, each with ordinal response options, each option associated with a text description ranging from 'Not at all' to 'Nearly every day'. Seven-Item Scale: Sum of responses for the seven symptoms (weighted by 7/6 if only 6 items answered). (Strong floor effect.) Theoretical range: 0-21 Actual range: 0-21 Higher value indicates worse outcome (i.e., higher level of anxiety symptoms) Unit of measurement: scores on a scale

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=171 Participants Received "Jumpstart" feedback forms and education	Patient Control n=196 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Generalized Anxiety Disorder (GAD-7): Seven-Item Scale	—	—	—	—	2 scores on a scale Interval 0.0 to 5.0	2 scores on a scale Interval 0.0 to 4.0	—	—	—

SECONDARY outcome

Timeframe: 6 months after target visit

Outcome measures

Outcome measures
Measure	Clinician Intervention Received "Jumpstart" feedback forms and education	Clinician Control Received/Provided usual care, surveys only	IP Team Intervention Received "Jumpstart" feedback forms and education	IP Team Control Received/Provided usual care, surveys only	Patient Intervention n=127 Participants Received "Jumpstart" feedback forms and education	Patient Control n=150 Participants Received usual care, surveys only	Family Member Intervention Received "Jumpstart" feedback forms and education	Family Member Control Received usual care, surveys only	Interviewees Key informants: Clinicians, Patients and Family Members
Generalized Anxiety Disorder (GAD-7): Two-Indicator Latent Construct	—	—	—	—	0.297 scores on a scale Standard Deviation 0.847	0.209 scores on a scale Standard Deviation 0.935	—	—	—

SECONDARY outcome

Timeframe: 6 months after target visit

Population: Survey items asked of patients at 6-months. Some intervention and control patients did not provide valid responses on 6+ items.

Generalized Anxiety Disorder: A self-report measure of anxiety symptoms. Seven symptoms, each with ordinal response options, each option associated with a text description ranging from 'Not at all' to 'Nearly every day'. Seven-Item Scale: Sum of responses for the seven symptoms (weighted by 7/6 if only 6 items answered). (Strong floor effect.) Theoretical range: 0-21 Actual range: 0-21 Higher value indicates worse outcome (i.e., higher level of anxiety symptoms) Unit of measurement: scores on a scale