Feasibility and Effectiveness of Virtual Group Advance Care Planning Visits During the COVID-19 Pandemic.
Lindsey Yourman, Alina Pollner, Jasmine Khatibi and 5 others
PMID 38896819WHAT IT FOUND
Goals-of-care conversations were documented for 100% in-person and 93% virtual participants after a program that included group visits, mailed materials, pre-visit calls, physician facilitation, volunteer and clinic staff support, family members, and document scanning, but only attendees were followed.
Key findings
01The primary outcome, documented goals-of-care conversations, was 25% before in-person visits and 31% before virtual visits, then 100% and 93% at 6-month follow-up.
02Only 17 of 344 patients referred through the electronic record attended, a 4.9% reach.
03Participants said virtual visits removed travel and let family from out-of-state join, and that mute, video, chat, and screen sharing let them choose their level of participation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 17 of 344 patients referred through the electronic record attended, so the results may not apply to patients who are not already interested in advance care planning. The paper did not collect data from patients who did not attend, so it cannot compare outcomes between attendees and non-attendees. The in-person group had 16 participants, and the paper says few patients participated in-person compared with virtual, which limits conclusions about differences between formats. Participants were mostly older white adults, and educational level was not collected, so results may differ in more diverse populations. The intervention included multiple components, so the contribution of any single component cannot be separated. Virtual visits required volunteers, mailing, pre-visit calls, and technology troubleshooting, which may be hard to sustain. Zoom technical problems and hearing or vision loss affected participation. The study did not evaluate maintenance, and billing for group visits was not intuitive.
Declared interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The easy way to misread this
Do not read the 100% and 93% goals-of-care conversation rates as proof that virtual group visits alone caused the conversations. Participants also received mailed materials, pre-visit calls, physician facilitation, volunteer and clinic staff support, family member participation, and document scanning, so the contribution of any single component cannot be separated.