Trial Outcomes & Findings for Patient-centered and Efficacious Advance Care Planning in Cancer: the PEACe Comparative Effectiveness Trial (NCT NCT03824158)

Last Updated: 2026-01-14

Results Overview

15-item Advance Care Planning (ACP) engagement survey assesses ACP processes related to choosing a medical decision maker, discussing and documenting preference for care at end of life, flexibility for surrogate decision making, and asking questions of medical providers. A single summary score will be reported (range 0-5 with higher scores indicating higher engagement).

Recruitment status

COMPLETED

Study phase

Target enrollment

672 participants

Primary outcome timeframe

12 weeks

Results posted on

2026-01-14

Participant Flow

Recruitment occurred from August 1, 2019 until July 14, 2023. Patients were enrolled from 8 oncology clinics within the University of Pittsburgh Medical Center Hillman Cancer Center Network in western Pennsylvania. Patients were encouraged but not required to identify a caregiver, defined as the primary adult (family member or friend) involved in their care and best able to participate in the study, as assessed by the patient. Patients without a willing caregiver participant were not excluded.

Participant milestones

Participant milestones
Measure	Web-based Advance Care Planning (PATIENTS) Patients randomized to this arm will participate in web-based ACP via the PREPARE website. Web-based advance care planning: Instructions for accessing and using the PREPARE website will be shared with participants upon randomization. Patients and their caregivers review the 5 steps of PREPARE (approximately 10 minutes per step) and create an action plan for each step. The PREPARE website includes a link to a written advance directive that participants are able to complete. The PREPARE website can be reviewed on a home computer or on a tablet in the oncology practice.	Facilitated Advance Care Planning (In-person or Telephonic) (PATIENTS) Patients randomized to this arm will participate in in-person or telephonic facilitated advance care planning (ACP) discussions using the Respecting Choices model. Facilitated advance care planning (in-person or telephonic): The facilitator will contact the patient to schedule the ACP discussion. ACP discussions will be led by a nurse or social worker with supportive oncology experience who has been trained as a Respecting Choices facilitator, include the patient's caregiver when available, last 45-60 minutes, and be held in a private location at or near the patient's oncology clinic, or telephonically. Facilitators will use a structured interview tool as a discussion roadmap and provide guidance in choosing a medical decision maker, exploring serious illness understanding and experiences, identifying goals and values, and making future treatment decisions. Facilitators will provide a copy of a written advance directive, assist with completion when appropriate, and make recommendations for communicating goals and sharing written preferences.	Web-based Advance Care Planning (CAREGIVERS) Enrolled caregivers of patients randomized to the web-based advance care planning arm.	Facilitated Advance Care Planning (In-person or Telephonic) (CAREGIVERS) Enrolled caregivers of patients randomized to the facilitated advance care planning arm.
Overall Study STARTED	203	197	133	139
Overall Study COMPLETED	134	135	102	108
Overall Study NOT COMPLETED	69	62	31	31

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Web-based Advance Care Planning (PATIENTS) n=203 Participants Patients randomized to this arm will participate in web-based ACP via the PREPARE website. Web-based advance care planning: Instructions for accessing and using the PREPARE website will be shared with participants upon randomization. Patients and their caregivers review the 5 steps of PREPARE (approximately 10 minutes per step) and create an action plan for each step. The PREPARE website includes a link to a written advance directive that participants are able to complete. The PREPARE website can be reviewed on a home computer or on a tablet in the oncology practice.	Facilitated Advance Care Planning (In-person or Telephonic) (PATIENTS) n=197 Participants Patients randomized to this arm will participate in in-person or telephonic facilitated advance care planning (ACP) discussions using the Respecting Choices model. Facilitated advance care planning (in-person or telephonic): The facilitator will contact the patient to schedule the ACP discussion. ACP discussions will be led by a nurse or social worker with supportive oncology experience who has been trained as a Respecting Choices facilitator, include the patient's caregiver when available, last 45-60 minutes, and be held in a private location at or near the patient's oncology clinic, or telephonically. Facilitators will use a structured interview tool as a discussion roadmap and provide guidance in choosing a medical decision maker, exploring serious illness understanding and experiences, identifying goals and values, and making future treatment decisions. Facilitators will provide a copy of a written advance directive, assist with completion when appropriate, and make recommendations for communicating goals and sharing written preferences.	Web-based Advance Care Planning (CAREGIVERS) n=133 Participants Enrolled caregivers of patients randomized to the web-based advance care planning arm.	Facilitated Advance Care Planning (In-person or Telephonic) (CAREGIVERS) n=139 Participants Enrolled caregivers of patients randomized to the facilitated advance care planning arm.	Total n=672 Participants Total of all reporting groups
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=203 Participants	0 Participants n=197 Participants	0 Participants n=133 Participants	0 Participants n=139 Participants	0 Participants n=672 Participants
Age, Continuous	67.8 years STANDARD_DEVIATION 10 • n=203 Participants	68.1 years STANDARD_DEVIATION 11 • n=197 Participants	62.2 years STANDARD_DEVIATION 13.6 • n=133 Participants	61.9 years STANDARD_DEVIATION 13.5 • n=139 Participants	67.9 years STANDARD_DEVIATION 10.5 • n=672 Participants
Sex: Female, Male Female	96 Participants n=203 Participants	96 Participants n=197 Participants	96 Participants n=133 Participants	103 Participants n=139 Participants	391 Participants n=672 Participants
Sex: Female, Male Male	107 Participants n=203 Participants	101 Participants n=197 Participants	37 Participants n=133 Participants	36 Participants n=139 Participants	281 Participants n=672 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	1 Participants n=203 Participants	3 Participants n=197 Participants	1 Participants n=133 Participants	1 Participants n=139 Participants	6 Participants n=672 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	201 Participants n=203 Participants	194 Participants n=197 Participants	132 Participants n=133 Participants	136 Participants n=139 Participants	663 Participants n=672 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	1 Participants n=203 Participants	0 Participants n=197 Participants	0 Participants n=133 Participants	2 Participants n=139 Participants	3 Participants n=672 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=203 Participants	1 Participants n=197 Participants	0 Participants n=133 Participants	1 Participants n=139 Participants	2 Participants n=672 Participants
Race (NIH/OMB) Asian	1 Participants n=203 Participants	1 Participants n=197 Participants	1 Participants n=133 Participants	1 Participants n=139 Participants	4 Participants n=672 Participants
Race (NIH/OMB) Black or African American	17 Participants n=203 Participants	13 Participants n=197 Participants	6 Participants n=133 Participants	5 Participants n=139 Participants	41 Participants n=672 Participants
Race (NIH/OMB) White	184 Participants n=203 Participants	181 Participants n=197 Participants	125 Participants n=133 Participants	132 Participants n=139 Participants	622 Participants n=672 Participants
Race (NIH/OMB) More than one race	1 Participants n=203 Participants	1 Participants n=197 Participants	1 Participants n=133 Participants	0 Participants n=139 Participants	3 Participants n=672 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants n=203 Participants	0 Participants n=197 Participants	0 Participants n=133 Participants	0 Participants n=139 Participants	0 Participants n=672 Participants
Region of Enrollment United States	203 participants n=203 Participants	197 participants n=197 Participants	133 participants n=133 Participants	139 participants n=139 Participants	672 participants n=672 Participants
Education Level < High school	4 Participants n=203 Participants	6 Participants n=197 Participants	1 Participants n=133 Participants	3 Participants n=139 Participants	14 Participants n=672 Participants
Education Level High school diploma or GED	66 Participants n=203 Participants	63 Participants n=197 Participants	34 Participants n=133 Participants	36 Participants n=139 Participants	199 Participants n=672 Participants
Education Level Some college or college degree	107 Participants n=203 Participants	99 Participants n=197 Participants	74 Participants n=133 Participants	69 Participants n=139 Participants	349 Participants n=672 Participants
Education Level Graduate or professional degree	25 Participants n=203 Participants	28 Participants n=197 Participants	24 Participants n=133 Participants	31 Participants n=139 Participants	108 Participants n=672 Participants
Education Level Refused to answer	1 Participants n=203 Participants	1 Participants n=197 Participants	0 Participants n=133 Participants	0 Participants n=139 Participants	2 Participants n=672 Participants
Current Marital Status Never married	16 Participants n=203 Participants	14 Participants n=197 Participants	12 Participants n=133 Participants	6 Participants n=139 Participants	48 Participants n=672 Participants
Current Marital Status Married	125 Participants n=203 Participants	118 Participants n=197 Participants	105 Participants n=133 Participants	113 Participants n=139 Participants	461 Participants n=672 Participants
Current Marital Status Widowed	28 Participants n=203 Participants	35 Participants n=197 Participants	6 Participants n=133 Participants	9 Participants n=139 Participants	78 Participants n=672 Participants
Current Marital Status Divorced/Separated	28 Participants n=203 Participants	28 Participants n=197 Participants	8 Participants n=133 Participants	10 Participants n=139 Participants	74 Participants n=672 Participants
Current Marital Status Refused to answer	5 Participants n=203 Participants	0 Participants n=197 Participants	2 Participants n=133 Participants	1 Participants n=139 Participants	8 Participants n=672 Participants
Current Marital Status Unknown	1 Participants n=203 Participants	2 Participants n=197 Participants	0 Participants n=133 Participants	0 Participants n=139 Participants	3 Participants n=672 Participants
Ability to manage on income Cannot make ends meet	6 Participants n=203 Participants	2 Participants n=197 Participants	8 Participants n=133 Participants	2 Participants n=139 Participants	18 Participants n=672 Participants
Ability to manage on income Just manage to get by	51 Participants n=203 Participants	46 Participants n=197 Participants	21 Participants n=133 Participants	24 Participants n=139 Participants	142 Participants n=672 Participants
Ability to manage on income Have enough with a little extra	59 Participants n=203 Participants	77 Participants n=197 Participants	58 Participants n=133 Participants	54 Participants n=139 Participants	248 Participants n=672 Participants
Ability to manage on income Money is not a problem	56 Participants n=203 Participants	48 Participants n=197 Participants	35 Participants n=133 Participants	41 Participants n=139 Participants	180 Participants n=672 Participants
Ability to manage on income Refused to answer	27 Participants n=203 Participants	24 Participants n=197 Participants	11 Participants n=133 Participants	18 Participants n=139 Participants	80 Participants n=672 Participants
Ability to manage on income Unknown	4 Participants n=203 Participants	0 Participants n=197 Participants	0 Participants n=133 Participants	0 Participants n=139 Participants	4 Participants n=672 Participants
Religion Agnostic/Atheist/No religion	8 Participants n=203 Participants	14 Participants n=197 Participants	5 Participants n=133 Participants	9 Participants n=139 Participants	36 Participants n=672 Participants
Religion Buddhist	1 Participants n=203 Participants	0 Participants n=197 Participants	0 Participants n=133 Participants	0 Participants n=139 Participants	1 Participants n=672 Participants
Religion Catholic	91 Participants n=203 Participants	72 Participants n=197 Participants	57 Participants n=133 Participants	56 Participants n=139 Participants	276 Participants n=672 Participants
Religion Other Christian	24 Participants n=203 Participants	27 Participants n=197 Participants	12 Participants n=133 Participants	19 Participants n=139 Participants	82 Participants n=672 Participants
Religion Hindu	0 Participants n=203 Participants	1 Participants n=197 Participants	0 Participants n=133 Participants	1 Participants n=139 Participants	2 Participants n=672 Participants
Religion Jewish	3 Participants n=203 Participants	5 Participants n=197 Participants	3 Participants n=133 Participants	4 Participants n=139 Participants	15 Participants n=672 Participants
Religion Muslim	0 Participants n=203 Participants	0 Participants n=197 Participants	1 Participants n=133 Participants	0 Participants n=139 Participants	1 Participants n=672 Participants
Religion Protestant	42 Participants n=203 Participants	48 Participants n=197 Participants	33 Participants n=133 Participants	28 Participants n=139 Participants	151 Participants n=672 Participants
Religion Declined to answer	18 Participants n=203 Participants	16 Participants n=197 Participants	9 Participants n=133 Participants	8 Participants n=139 Participants	51 Participants n=672 Participants
Religion Other	15 Participants n=203 Participants	14 Participants n=197 Participants	13 Participants n=133 Participants	14 Participants n=139 Participants	56 Participants n=672 Participants
Religion Unknown	1 Participants n=203 Participants	0 Participants n=197 Participants	0 Participants n=133 Participants	0 Participants n=139 Participants	1 Participants n=672 Participants
Religious importance Not at all important	9 Participants n=203 Participants	20 Participants n=197 Participants	2 Participants n=133 Participants	8 Participants n=139 Participants	39 Participants n=672 Participants
Religious importance Not too important	24 Participants n=203 Participants	25 Participants n=197 Participants	17 Participants n=133 Participants	21 Participants n=139 Participants	87 Participants n=672 Participants
Religious importance Fairly important	53 Participants n=203 Participants	43 Participants n=197 Participants	39 Participants n=133 Participants	43 Participants n=139 Participants	178 Participants n=672 Participants
Religious importance Very important	106 Participants n=203 Participants	101 Participants n=197 Participants	68 Participants n=133 Participants	64 Participants n=139 Participants	339 Participants n=672 Participants
Religious importance Refused to answer	10 Participants n=203 Participants	7 Participants n=197 Participants	7 Participants n=133 Participants	3 Participants n=139 Participants	27 Participants n=672 Participants
Religious importance Unknown	1 Participants n=203 Participants	1 Participants n=197 Participants	0 Participants n=133 Participants	0 Participants n=139 Participants	2 Participants n=672 Participants
Confidence filling out medical forms Not at all	6 Participants n=203 Participants	7 Participants n=197 Participants	1 Participants n=133 Participants	3 Participants n=139 Participants	17 Participants n=672 Participants
Confidence filling out medical forms A little bit	9 Participants n=203 Participants	9 Participants n=197 Participants	4 Participants n=133 Participants	3 Participants n=139 Participants	25 Participants n=672 Participants
Confidence filling out medical forms Somewhat	54 Participants n=203 Participants	43 Participants n=197 Participants	16 Participants n=133 Participants	15 Participants n=139 Participants	128 Participants n=672 Participants
Confidence filling out medical forms Quite a bit	40 Participants n=203 Participants	47 Participants n=197 Participants	31 Participants n=133 Participants	33 Participants n=139 Participants	151 Participants n=672 Participants
Confidence filling out medical forms Extremely	94 Participants n=203 Participants	91 Participants n=197 Participants	81 Participants n=133 Participants	85 Participants n=139 Participants	351 Participants n=672 Participants
How many other people live in your household? 0	45 Participants n=203 Participants	49 Participants n=197 Participants	7 Participants n=133 Participants	10 Participants n=139 Participants	111 Participants n=672 Participants
How many other people live in your household? 1	112 Participants n=203 Participants	110 Participants n=197 Participants	90 Participants n=133 Participants	95 Participants n=139 Participants	407 Participants n=672 Participants
How many other people live in your household? 2	26 Participants n=203 Participants	24 Participants n=197 Participants	17 Participants n=133 Participants	17 Participants n=139 Participants	84 Participants n=672 Participants
How many other people live in your household? 3	14 Participants n=203 Participants	12 Participants n=197 Participants	14 Participants n=133 Participants	14 Participants n=139 Participants	54 Participants n=672 Participants
How many other people live in your household? 4+	4 Participants n=203 Participants	1 Participants n=197 Participants	5 Participants n=133 Participants	3 Participants n=139 Participants	13 Participants n=672 Participants
How many other people live in your household? Unknown	2 Participants n=203 Participants	1 Participants n=197 Participants	0 Participants n=133 Participants	0 Participants n=139 Participants	3 Participants n=672 Participants
Current employment status Working full-time	20 Participants n=203 Participants	21 Participants n=197 Participants	40 Participants n=133 Participants	46 Participants n=139 Participants	127 Participants n=672 Participants
Current employment status Working part-time	7 Participants n=203 Participants	7 Participants n=197 Participants	11 Participants n=133 Participants	12 Participants n=139 Participants	37 Participants n=672 Participants
Current employment status Unemployed	11 Participants n=203 Participants	9 Participants n=197 Participants	3 Participants n=133 Participants	2 Participants n=139 Participants	25 Participants n=672 Participants
Current employment status Retired	118 Participants n=203 Participants	120 Participants n=197 Participants	59 Participants n=133 Participants	62 Participants n=139 Participants	359 Participants n=672 Participants
Current employment status Homemaker (never worked for pay)	1 Participants n=203 Participants	4 Participants n=197 Participants	5 Participants n=133 Participants	3 Participants n=139 Participants	13 Participants n=672 Participants
Current employment status Disability	24 Participants n=203 Participants	22 Participants n=197 Participants	4 Participants n=133 Participants	6 Participants n=139 Participants	56 Participants n=672 Participants
Current employment status Other	16 Participants n=203 Participants	11 Participants n=197 Participants	10 Participants n=133 Participants	7 Participants n=139 Participants	44 Participants n=672 Participants
Current employment status Refused to answer	6 Participants n=203 Participants	3 Participants n=197 Participants	1 Participants n=133 Participants	1 Participants n=139 Participants	11 Participants n=672 Participants
HADS Survey Depression Subscale Scores	4.62 score on a scale STANDARD_DEVIATION 3.44 • n=203 Participants	4.69 score on a scale STANDARD_DEVIATION 3.52 • n=197 Participants	4.22 score on a scale STANDARD_DEVIATION 3.54 • n=133 Participants	3.96 score on a scale STANDARD_DEVIATION 3.43 • n=139 Participants	4.65 score on a scale STANDARD_DEVIATION 3.48 • n=672 Participants
HADS Survey Anxiety Subscale Scores	5.22 score on a scale STANDARD_DEVIATION 3.69 • n=203 Participants	5.15 score on a scale STANDARD_DEVIATION 3.73 • n=197 Participants	7.0 score on a scale STANDARD_DEVIATION 4.1 • n=133 Participants	7.44 score on a scale STANDARD_DEVIATION 4.43 • n=139 Participants	5.19 score on a scale STANDARD_DEVIATION 3.71 • n=672 Participants
Current living situation In a home I (or my family) own	161 Participants n=203 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	155 Participants n=197 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	316 Participants n=400 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.
Current living situation In a home I (or my family) rent	31 Participants n=203 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	28 Participants n=197 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	59 Participants n=400 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.
Current living situation In a Board and Care home	0 Participants n=203 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	0 Participants n=197 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	0 Participants n=400 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.
Current living situation In an Assisted Living Facility	2 Participants n=203 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	3 Participants n=197 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	5 Participants n=400 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.
Current living situation In a Nursing Home	0 Participants n=203 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	3 Participants n=197 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	3 Participants n=400 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.
Current living situation Other/Unsure	6 Participants n=203 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	8 Participants n=197 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	14 Participants n=400 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.
Current living situation Refused to answer	3 Participants n=203 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	0 Participants n=197 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	3 Participants n=400 Participants • Current living situation was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Genitourinary	21 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	20 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	41 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Brain	1 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	0 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	1 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Breast	18 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	31 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	49 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Gynecologic	7 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	12 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	19 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Gastrointestinal	39 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	38 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	77 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Hepatobiliary	9 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	8 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	17 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Head and Neck	10 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	10 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	20 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Lung	48 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	34 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	82 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Melanoma	1 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	0 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	1 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Caregiver lives with the patient	—	—	98 Participants n=133 Participants • Living with the enrolled patient was only collected for caregivers.	94 Participants n=139 Participants • Living with the enrolled patient was only collected for caregivers.	192 Participants n=272 Participants • Living with the enrolled patient was only collected for caregivers.
Cancer type Pancreatic	20 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	22 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	42 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Prostate	23 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	18 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	41 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Cancer type Other	6 Participants n=203 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	4 Participants n=197 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	10 Participants n=400 Participants • Cancer type was only collected for enrolled patients. Caregivers were not included in this measure.
Time since first diagnosed with cancer Less than one month ago	11 Participants n=203 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	6 Participants n=197 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	17 Participants n=400 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.
Time since first diagnosed with cancer ≥ 1 month but < 6 months ago	27 Participants n=203 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	31 Participants n=197 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	58 Participants n=400 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.
Time since first diagnosed with cancer ≥ 6 months but < 1 year ago	44 Participants n=203 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	43 Participants n=197 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	87 Participants n=400 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.
Time since first diagnosed with cancer ≥ 1 year but < 2 years ago	31 Participants n=203 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	23 Participants n=197 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	54 Participants n=400 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.
Time since first diagnosed with cancer ≥ 2 years but < 5 years ago	36 Participants n=203 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	39 Participants n=197 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	75 Participants n=400 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.
Time since first diagnosed with cancer ≥ 5 years ago	49 Participants n=203 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	53 Participants n=197 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	102 Participants n=400 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.
Time since first diagnosed with cancer Refused to answer	4 Participants n=203 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	2 Participants n=197 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	6 Participants n=400 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.
Time since first diagnosed with cancer Unknown	1 Participants n=203 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	0 Participants n=197 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	1 Participants n=400 Participants • Time since first diagnosed with cancer was only collected for enrolled patients. Caregivers were not included in this measure.
Time receiving care from current oncologist Less than one month	13 Participants n=203 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	11 Participants n=197 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	24 Participants n=400 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.
Time receiving care from current oncologist ≥ 1 month but < 6 months	40 Participants n=203 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	36 Participants n=197 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	76 Participants n=400 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.
Time receiving care from current oncologist ≥ 6 months but < 1 year	48 Participants n=203 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	51 Participants n=197 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	99 Participants n=400 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.
Time receiving care from current oncologist ≥ 1 year but < 2 years	35 Participants n=203 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	29 Participants n=197 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	64 Participants n=400 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.
Time receiving care from current oncologist ≥ 2 years but < 5 years	41 Participants n=203 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	39 Participants n=197 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	80 Participants n=400 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.
Time receiving care from current oncologist ≥ 5 years	23 Participants n=203 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	31 Participants n=197 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	54 Participants n=400 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.
Time receiving care from current oncologist Refused to answer	3 Participants n=203 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	0 Participants n=197 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	3 Participants n=400 Participants • Time receiving care from current oncologist was only collected for enrolled patients. Caregivers were not included in this measure.
ECOG Performance Status ECOG Score - 0	64 Participants n=203 Participants • ECOG score was only collected for enrolled patients. Caregivers were not included in this measure.	68 Participants n=197 Participants • ECOG score was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	132 Participants n=400 Participants • ECOG score was only collected for enrolled patients. Caregivers were not included in this measure.
Current care provider for the patient	—	—	117 Participants n=133 Participants • Care provider status was only collected for caregivers.	124 Participants n=139 Participants • Care provider status was only collected for caregivers.	241 Participants n=272 Participants • Care provider status was only collected for caregivers.
ECOG Performance Status ECOG Score - 1	122 Participants n=203 Participants • ECOG score was only collected for enrolled patients. Caregivers were not included in this measure.	102 Participants n=197 Participants • ECOG score was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	224 Participants n=400 Participants • ECOG score was only collected for enrolled patients. Caregivers were not included in this measure.
ECOG Performance Status ECOG Score - 2	17 Participants n=203 Participants • ECOG score was only collected for enrolled patients. Caregivers were not included in this measure.	27 Participants n=197 Participants • ECOG score was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	44 Participants n=400 Participants • ECOG score was only collected for enrolled patients. Caregivers were not included in this measure.
Patient reported previously completing a living will or advance directive	95 Participants n=203 Participants • Previous living will or advance directive completion was only collected for enrolled patients. Caregivers were not included in this measure.	103 Participants n=197 Participants • Previous living will or advance directive completion was only collected for enrolled patients. Caregivers were not included in this measure.	—	—	198 Participants n=400 Participants • Previous living will or advance directive completion was only collected for enrolled patients. Caregivers were not included in this measure.
Patient reported previously having advance care planning discussions with caregivers	139 Participants n=203 Participants • Previous advance care planning discussions were only collected for enrolled patients. Caregivers were not included in this measure.	136 Participants n=197 Participants • Previous advance care planning discussions were only collected for enrolled patients. Caregivers were not included in this measure.	—	—	275 Participants n=400 Participants • Previous advance care planning discussions were only collected for enrolled patients. Caregivers were not included in this measure.
Patient reported previously having advance care planning discussions with physicians	48 Participants n=203 Participants • Previous advance care planning discussions were only collected for enrolled patients. Caregivers were not included in this measure.	53 Participants n=197 Participants • Previous advance care planning discussions were only collected for enrolled patients. Caregivers were not included in this measure.	—	—	101 Participants n=400 Participants • Previous advance care planning discussions were only collected for enrolled patients. Caregivers were not included in this measure.
Prior living will or advance directive in the medical record	24 Participants n=203 Participants • Living will or advance directive information was collected only for patients.	27 Participants n=197 Participants • Living will or advance directive information was collected only for patients.	—	—	51 Participants n=400 Participants • Living will or advance directive information was collected only for patients.
Prior POLST form in the medical record	4 Participants n=203 Participants • POLST form information was collected only for patients.	8 Participants n=197 Participants • POLST form information was collected only for patients.	—	—	12 Participants n=400 Participants • POLST form information was collected only for patients.
Advance Care Planning (ACP) Engagement Survey Total Scores	3.66 score on a scale STANDARD_DEVIATION 0.93 • n=203 Participants • Advance Care Planning Engagement scores were only collected for enrolled patients. Caregivers were not included in this measure.	3.74 score on a scale STANDARD_DEVIATION 1.02 • n=197 Participants • Advance Care Planning Engagement scores were only collected for enrolled patients. Caregivers were not included in this measure.	—	—	3.70 score on a scale STANDARD_DEVIATION 0.98 • n=400 Participants • Advance Care Planning Engagement scores were only collected for enrolled patients. Caregivers were not included in this measure.
Relationship to enrolled patient Spouse/partner	—	—	90 Participants n=133 Participants • Relationship to enrolled patient was only collected for caregivers.	85 Participants n=139 Participants • Relationship to enrolled patient was only collected for caregivers.	175 Participants n=272 Participants • Relationship to enrolled patient was only collected for caregivers.
Relationship to enrolled patient Child	—	—	25 Participants n=133 Participants • Relationship to enrolled patient was only collected for caregivers.	24 Participants n=139 Participants • Relationship to enrolled patient was only collected for caregivers.	49 Participants n=272 Participants • Relationship to enrolled patient was only collected for caregivers.
Relationship to enrolled patient Parent	—	—	5 Participants n=133 Participants • Relationship to enrolled patient was only collected for caregivers.	4 Participants n=139 Participants • Relationship to enrolled patient was only collected for caregivers.	9 Participants n=272 Participants • Relationship to enrolled patient was only collected for caregivers.
Relationship to enrolled patient Sibling	—	—	6 Participants n=133 Participants • Relationship to enrolled patient was only collected for caregivers.	12 Participants n=139 Participants • Relationship to enrolled patient was only collected for caregivers.	18 Participants n=272 Participants • Relationship to enrolled patient was only collected for caregivers.
Relationship to enrolled patient Friend	—	—	2 Participants n=133 Participants • Relationship to enrolled patient was only collected for caregivers.	5 Participants n=139 Participants • Relationship to enrolled patient was only collected for caregivers.	7 Participants n=272 Participants • Relationship to enrolled patient was only collected for caregivers.
Relationship to enrolled patient Other	—	—	4 Participants n=133 Participants • Relationship to enrolled patient was only collected for caregivers.	9 Participants n=139 Participants • Relationship to enrolled patient was only collected for caregivers.	13 Participants n=272 Participants • Relationship to enrolled patient was only collected for caregivers.
Relationship to enrolled patient Refused to answer	—	—	1 Participants n=133 Participants • Relationship to enrolled patient was only collected for caregivers.	0 Participants n=139 Participants • Relationship to enrolled patient was only collected for caregivers.	1 Participants n=272 Participants • Relationship to enrolled patient was only collected for caregivers.
Average days per week providing care	—	—	5.33 days per week STANDARD_DEVIATION 2.3 • n=133 Participants • Average days providing care was only collected for caregivers.	5.59 days per week STANDARD_DEVIATION 2.3 • n=139 Participants • Average days providing care was only collected for caregivers.	5.46 days per week STANDARD_DEVIATION 2.3 • n=272 Participants • Average days providing care was only collected for caregivers.
Average hours per day providing care	—	—	6.92 hours per day STANDARD_DEVIATION 8.1 • n=133 Participants • Average hours providing care was only collected for caregivers.	7.15 hours per day STANDARD_DEVIATION 7.9 • n=139 Participants • Average hours providing care was only collected for caregivers.	7.03 hours per day STANDARD_DEVIATION 8.0 • n=272 Participants • Average hours providing care was only collected for caregivers.
Currently providing care for anyone else	—	—	29 Participants n=133 Participants • Providing care for anyone else was only collected for caregivers.	31 Participants n=139 Participants • Providing care for anyone else was only collected for caregivers.	60 Participants n=272 Participants • Providing care for anyone else was only collected for caregivers.

PRIMARY outcome

Timeframe: 12 weeks

Population: Number of participants that completed 12 week outcomes assessment.

Outcome measures

Outcome measures
Measure	Web-based Advance Care Planning (PATIENTS) n=134 Participants Patients randomized to this arm will participate in web-based ACP via the PREPARE website. Web-based advance care planning: Instructions for accessing and using the PREPARE website will be shared with participants upon randomization. Patients and their caregivers review the 5 steps of PREPARE (approximately 10 minutes per step) and create an action plan for each step. The PREPARE website includes a link to a written advance directive that participants are able to complete. The PREPARE website can be reviewed on a home computer or on a tablet in the oncology practice.	Facilitated Advance Care Planning (In-person or Telephonic) (PATIENTS) n=135 Participants Patients randomized to this arm will participate in in-person or telephonic facilitated advance care planning (ACP) discussions using the Respecting Choices model. Facilitated advance care planning (in-person or telephonic): The facilitator will contact the patient to schedule the ACP discussion. ACP discussions will be led by a nurse or social worker with supportive oncology experience who has been trained as a Respecting Choices facilitator, include the patient's caregiver when available, last 45-60 minutes, and be held in a private location at or near the patient's oncology clinic, or telephonically. Facilitators will use a structured interview tool as a discussion roadmap and provide guidance in choosing a medical decision maker, exploring serious illness understanding and experiences, identifying goals and values, and making future treatment decisions. Facilitators will provide a copy of a written advance directive, assist with completion when appropriate, and make recommendations for communicating goals and sharing written preferences.
Advance Care Planning Engagement	4.08 score on a scale Standard Deviation 0.82	4.34 score on a scale Standard Deviation 0.78

SECONDARY outcome

Timeframe: 12 weeks

Population: Number of participants that completed 12 week outcomes assessment.

"Has \[participant\] talked with \[participant's\] family or friends about the kind of medical care \[participant\] would want if \[participant\] were very sick or near the end of life?"

Outcome measures

Outcome measures
Measure	Web-based Advance Care Planning (PATIENTS) n=134 Participants Patients randomized to this arm will participate in web-based ACP via the PREPARE website. Web-based advance care planning: Instructions for accessing and using the PREPARE website will be shared with participants upon randomization. Patients and their caregivers review the 5 steps of PREPARE (approximately 10 minutes per step) and create an action plan for each step. The PREPARE website includes a link to a written advance directive that participants are able to complete. The PREPARE website can be reviewed on a home computer or on a tablet in the oncology practice.	Facilitated Advance Care Planning (In-person or Telephonic) (PATIENTS) n=135 Participants Patients randomized to this arm will participate in in-person or telephonic facilitated advance care planning (ACP) discussions using the Respecting Choices model. Facilitated advance care planning (in-person or telephonic): The facilitator will contact the patient to schedule the ACP discussion. ACP discussions will be led by a nurse or social worker with supportive oncology experience who has been trained as a Respecting Choices facilitator, include the patient's caregiver when available, last 45-60 minutes, and be held in a private location at or near the patient's oncology clinic, or telephonically. Facilitators will use a structured interview tool as a discussion roadmap and provide guidance in choosing a medical decision maker, exploring serious illness understanding and experiences, identifying goals and values, and making future treatment decisions. Facilitators will provide a copy of a written advance directive, assist with completion when appropriate, and make recommendations for communicating goals and sharing written preferences.
Number of Participants Who Have Had Advance Care Planning Discussions With Caregivers	117 Participants	120 Participants

SECONDARY outcome

Timeframe: 12 weeks

Population: Number of participants that completed 12 week outcomes assessment.

"Has \[participant\] talked with \[participant's\] doctor about the kind of medical care \[participant\] would want if \[participant\] were very sick or near the end of life?"

Outcome measures

Outcome measures
Measure	Web-based Advance Care Planning (PATIENTS) n=134 Participants Patients randomized to this arm will participate in web-based ACP via the PREPARE website. Web-based advance care planning: Instructions for accessing and using the PREPARE website will be shared with participants upon randomization. Patients and their caregivers review the 5 steps of PREPARE (approximately 10 minutes per step) and create an action plan for each step. The PREPARE website includes a link to a written advance directive that participants are able to complete. The PREPARE website can be reviewed on a home computer or on a tablet in the oncology practice.	Facilitated Advance Care Planning (In-person or Telephonic) (PATIENTS) n=135 Participants Patients randomized to this arm will participate in in-person or telephonic facilitated advance care planning (ACP) discussions using the Respecting Choices model. Facilitated advance care planning (in-person or telephonic): The facilitator will contact the patient to schedule the ACP discussion. ACP discussions will be led by a nurse or social worker with supportive oncology experience who has been trained as a Respecting Choices facilitator, include the patient's caregiver when available, last 45-60 minutes, and be held in a private location at or near the patient's oncology clinic, or telephonically. Facilitators will use a structured interview tool as a discussion roadmap and provide guidance in choosing a medical decision maker, exploring serious illness understanding and experiences, identifying goals and values, and making future treatment decisions. Facilitators will provide a copy of a written advance directive, assist with completion when appropriate, and make recommendations for communicating goals and sharing written preferences.
Number of Participants Who Have Had Advance Care Planning Discussions With Physicians	54 Participants	67 Participants

SECONDARY outcome

Timeframe: 12 weeks

Population: Number of participants that completed 12 week outcomes assessment.

"Has \[participant\] completed a living will or advance directive?"

Outcome measures

Outcome measures
Measure	Web-based Advance Care Planning (PATIENTS) n=134 Participants Patients randomized to this arm will participate in web-based ACP via the PREPARE website. Web-based advance care planning: Instructions for accessing and using the PREPARE website will be shared with participants upon randomization. Patients and their caregivers review the 5 steps of PREPARE (approximately 10 minutes per step) and create an action plan for each step. The PREPARE website includes a link to a written advance directive that participants are able to complete. The PREPARE website can be reviewed on a home computer or on a tablet in the oncology practice.	Facilitated Advance Care Planning (In-person or Telephonic) (PATIENTS) n=135 Participants Patients randomized to this arm will participate in in-person or telephonic facilitated advance care planning (ACP) discussions using the Respecting Choices model. Facilitated advance care planning (in-person or telephonic): The facilitator will contact the patient to schedule the ACP discussion. ACP discussions will be led by a nurse or social worker with supportive oncology experience who has been trained as a Respecting Choices facilitator, include the patient's caregiver when available, last 45-60 minutes, and be held in a private location at or near the patient's oncology clinic, or telephonically. Facilitators will use a structured interview tool as a discussion roadmap and provide guidance in choosing a medical decision maker, exploring serious illness understanding and experiences, identifying goals and values, and making future treatment decisions. Facilitators will provide a copy of a written advance directive, assist with completion when appropriate, and make recommendations for communicating goals and sharing written preferences.
Number of Participants Who Have Completed an Advance Directive	80 Participants	101 Participants

SECONDARY outcome

Timeframe: 12 weeks

Investigators will assess documented care goals by reviewing medical records for any care goals documented since baseline (Yes/No).

Outcome measures

Outcome measures
Measure	Web-based Advance Care Planning (PATIENTS) n=203 Participants Patients randomized to this arm will participate in web-based ACP via the PREPARE website. Web-based advance care planning: Instructions for accessing and using the PREPARE website will be shared with participants upon randomization. Patients and their caregivers review the 5 steps of PREPARE (approximately 10 minutes per step) and create an action plan for each step. The PREPARE website includes a link to a written advance directive that participants are able to complete. The PREPARE website can be reviewed on a home computer or on a tablet in the oncology practice.	Facilitated Advance Care Planning (In-person or Telephonic) (PATIENTS) n=197 Participants Patients randomized to this arm will participate in in-person or telephonic facilitated advance care planning (ACP) discussions using the Respecting Choices model. Facilitated advance care planning (in-person or telephonic): The facilitator will contact the patient to schedule the ACP discussion. ACP discussions will be led by a nurse or social worker with supportive oncology experience who has been trained as a Respecting Choices facilitator, include the patient's caregiver when available, last 45-60 minutes, and be held in a private location at or near the patient's oncology clinic, or telephonically. Facilitators will use a structured interview tool as a discussion roadmap and provide guidance in choosing a medical decision maker, exploring serious illness understanding and experiences, identifying goals and values, and making future treatment decisions. Facilitators will provide a copy of a written advance directive, assist with completion when appropriate, and make recommendations for communicating goals and sharing written preferences.
Documented Care Goals New Goals of Care discussion	26 participants	22 participants
Documented Care Goals New advance directive or living will	4 participants	18 participants
Documented Care Goals New Physician Orders for Life-sustaining Treatment (POLST) form	1 participants	8 participants
Documented Care Goals New Code Status	29 participants	31 participants

SECONDARY outcome

Timeframe: 12 weeks

Depression subscale of the 14-item Hospital Anxiety and Depression Scale (HADS) will be used to assess caregiver depression symptoms at 12 weeks and bereavement. The HADS depression subscale scores range from 0 to 21, with higher scores indicating more distress.

Outcome measures

Outcome measures
Measure	Web-based Advance Care Planning (PATIENTS) n=102 Participants Patients randomized to this arm will participate in web-based ACP via the PREPARE website. Web-based advance care planning: Instructions for accessing and using the PREPARE website will be shared with participants upon randomization. Patients and their caregivers review the 5 steps of PREPARE (approximately 10 minutes per step) and create an action plan for each step. The PREPARE website includes a link to a written advance directive that participants are able to complete. The PREPARE website can be reviewed on a home computer or on a tablet in the oncology practice.	Facilitated Advance Care Planning (In-person or Telephonic) (PATIENTS) n=108 Participants Patients randomized to this arm will participate in in-person or telephonic facilitated advance care planning (ACP) discussions using the Respecting Choices model. Facilitated advance care planning (in-person or telephonic): The facilitator will contact the patient to schedule the ACP discussion. ACP discussions will be led by a nurse or social worker with supportive oncology experience who has been trained as a Respecting Choices facilitator, include the patient's caregiver when available, last 45-60 minutes, and be held in a private location at or near the patient's oncology clinic, or telephonically. Facilitators will use a structured interview tool as a discussion roadmap and provide guidance in choosing a medical decision maker, exploring serious illness understanding and experiences, identifying goals and values, and making future treatment decisions. Facilitators will provide a copy of a written advance directive, assist with completion when appropriate, and make recommendations for communicating goals and sharing written preferences.
Caregiver Depression Symptoms	4.34 score on a scale Standard Deviation 4.07	3.69 score on a scale Standard Deviation 3.57

SECONDARY outcome

Timeframe: 12 weeks

Anxiety subscale of the 14-item Hospital Anxiety and Depression Scale (HADS) will be used to assess caregiver anxiety symptoms at 12 weeks and bereavement. The anxiety subscale scores range from 0 to 21, with higher scores indicating more distress.