Trial Outcomes & Findings for Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly (NCT NCT03609177)

Last Updated: 2025-10-21

Results Overview

Any advance directive (e.g., living will, POLST, etc.) and changes of resuscitation orders or any indication in the EHR of a goals-of-care or advance care planning conversation

Recruitment status

COMPLETED

Study phase

Target enrollment

13800 participants

Primary outcome timeframe

6 months

Results posted on

2025-10-21

Participant Flow

Recruitment was from April, 2020 - November, 2022. Locations: 36 cancer clinics

This is a stepped-wedge, cluster randomized trial where clinics were randomized at various steps to move from a control period to the intervention periods. A total of 13,800 unique participants from 29 clinics were enrolled in the study. Participants could have contributed data multiple times during any step of the study.

Unit of analysis: clinic

Participant milestones

Participant milestones
Measure	Sequence 1: Control (6 Months), Intervention (24 Months) Clinics participated in a baseline control period for 6 months followed by 24 months of intervention	Sequence 2: Control (12 Months), Intervention (18 Months) Clinics participated in control periods for 12 months followed by 18 months of intervention	Sequence 3: Control (18 Months), Intervention (12 Months) Clinics participated in control periods for 18 months followed by 12 months of intervention	Sequence 4: Control (24 Months), Intervention (6 Months) Clinics participated in control periods for 24 months followed by 6 months of intervention
Baseline STARTED	1571 6	1604 9	1151 9	1376 5
Baseline Intervention	0 0	0 0	0 0	0 0
Baseline Control	1571 6	1604 9	1151 9	1376 5
Baseline COMPLETED	1571 6	1604 0	1151 0	1376 5
Baseline NOT COMPLETED	0 0	0 9	0 9	0 0
Step 1 STARTED	1593 6	1538 9	1152 9	1253 5
Step 1 Intervention	1593 6	0 0	0 0	0 0
Step 1 Control	0 0	1538 9	1152 9	1253 5
Step 1 COMPLETED	1593 6	1538 9	1152 9	1253 5
Step 1 NOT COMPLETED	0 0	0 0	0 0	0 0
Step 2 STARTED	1741 6	1589 9	1033 6	1440 5
Step 2 Intervention	1741 6	1589 9	0 0	0 0
Step 2 Control	0 0	0 0	1033 6	1440 5
Step 2 COMPLETED	1741 6	1589 9	1033 6	1440 5
Step 2 NOT COMPLETED	0 0	0 0	0 0	0 0
Step 3 STARTED	1961 6	1464 9	1177 9	1485 5
Step 3 Intervention	1961 6	1464 9	1177 9	0 0
Step 3 Control	0 0	0 0	0 0	1485 5
Step 3 COMPLETED	1961 6	1461 9	1177 9	1485 5
Step 3 NOT COMPLETED	0 0	3 0	0 0	0 0
Step 4 STARTED	1789 6	1519 9	1318 9	1603 5
Step 4 Intervention	1789 6	1519 9	1318 9	1603 5
Step 4 Control	0 0	0 0	0 0	0 0
Step 4 COMPLETED	1789 6	1519 9	1318 9	1603 5
Step 4 NOT COMPLETED	0 0	0 0	0 0	0 0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Intervention Arm n=15754 Participants Patients with cancer being seen at the 30 oncology clinics will be exposed to clinicians who have had communication skills training (Vital Talk) and who are using video decision aids (ACP Decisions). Our main outcome is advance care planning documentation. Clinician Communication Skills Training: Communication skills training Advance Care Planning (ACP) Decisions Videos Decisions Aids: ACP Decisions video decision aids Video Declarations (ViDec): Recording of patient advance care planning videos	Usual Care Arm n=13603 Participants Patients who were not exposed to any intervention	Total n=29357 Participants Total of all reporting groups
Age, Continuous	74.4 Years STANDARD_DEVIATION 6.6 • n=5 Participants	74.6 Years STANDARD_DEVIATION 6.7 • n=7 Participants	74.5 Years STANDARD_DEVIATION 6.6 • n=5 Participants
Sex: Female, Male Female	7284 Participants n=5 Participants	6729 Participants n=7 Participants	14013 Participants n=5 Participants
Sex: Female, Male Male	8470 Participants n=5 Participants	6874 Participants n=7 Participants	15344 Participants n=5 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	454 Participants n=5 Participants	392 Participants n=7 Participants	846 Participants n=5 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	14750 Participants n=5 Participants	12,801 Participants n=7 Participants	27551 Participants n=5 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	550 Participants n=5 Participants	410 Participants n=7 Participants	960 Participants n=5 Participants
Race (NIH/OMB) American Indian or Alaska Native	35 Participants n=5 Participants	27 Participants n=7 Participants	62 Participants n=5 Participants
Race (NIH/OMB) Asian	556 Participants n=5 Participants	479 Participants n=7 Participants	1035 Participants n=5 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	7 Participants n=5 Participants	3 Participants n=7 Participants	10 Participants n=5 Participants
Race (NIH/OMB) Black or African American	1978 Participants n=5 Participants	1455 Participants n=7 Participants	3433 Participants n=5 Participants
Race (NIH/OMB) White	11830 Participants n=5 Participants	10441 Participants n=7 Participants	22271 Participants n=5 Participants
Race (NIH/OMB) More than one race	1 Participants n=5 Participants	10 Participants n=7 Participants	11 Participants n=5 Participants
Race (NIH/OMB) Unknown or Not Reported	1347 Participants n=5 Participants	1188 Participants n=7 Participants	2535 Participants n=5 Participants
Language English	15096 Participants n=5 Participants	13067 Participants n=7 Participants	28163 Participants n=5 Participants
Language Other	554 Participants n=5 Participants	490 Participants n=7 Participants	1044 Participants n=5 Participants
Language Unknown	104 Participants n=5 Participants	46 Participants n=7 Participants	150 Participants n=5 Participants

PRIMARY outcome

Timeframe: 6 months

Population: The primary outcome measure was assessed at the participant level (all eligible patients) and not at the unit level.

Any advance directive (e.g., living will, POLST, etc.) and changes of resuscitation orders or any indication in the EHR of a goals-of-care or advance care planning conversation