SHARING Choices: A Pilot Study to Engage Family in Advance Care Planning of Older Adults With and Without Cognitive Impairment in the Primary Care Context.
Jennifer L Wolff, Danny Scerpella, Kimberly Cockey and 8 others
PMID 33325729WHAT IT FOUND
23 of 37 dyads engaged one or more SHARING Choices components: clinic letter, blank directive, agenda-setting checklist, facilitator conversations, and shared portal access. 12 completed new and 16 shared existing directives.
Key findings
0123 of 37 dyads engaged one or more components, including clinic letter, blank advance directive, agenda-setting checklist, shared portal access, and ACP facilitator conversations.
02Among 12 patients who screened positive for cognitive impairment, 9 completed an ACP conversation; 3 completed a new advance directive and 7 provided a previously completed advance directive.
03Open-ended comments said the letter and agenda-setting checklist stimulated reflection and clarification of roles and preferences.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a pilot with no comparison group, so it cannot show that SHARING Choices improved advance care planning or engagement. It enrolled only older adults who consented and already attended primary care visits with family, so it may not apply to socially isolated patients. Participants were not racially or ethnically diverse. One health system had a clinic with prior advance care planning focus and a geriatrician who had led related quality improvement, which may have raised advance directive completion. Facilitator roles differed by system: an embedded social worker at System A and an offsite certified medical assistant at System B. The small sample included 37 dyads at 6 weeks.
Declared interests
The study received grant support from the National Institute on Aging. The funder had no role in design, conduct, or reporting. The authors declared no conflict of interest.
The easy way to misread this
Do not read the uptake as proof that the clinic letter, blank advance directive, agenda-setting checklist, facilitator conversations, or shared portal access improve outcomes. It was a pilot with no comparison group, and the contribution of any single component cannot be separated.