TY - JOUR
T1 - Effect of Emergency Department-Initiated Video-Enhanced Advance Care Planning on Documentation and Goal-Concordant Care
T2 - A Randomized Clinical Trial
AU - Volandes, Angelo E.
AU - Bohossian, Hacho
AU - Chang, Yuchiao
AU - Lindvall, Charlotta
AU - Paasche-Orlow, Michael K.
AU - Randa, Seth
AU - Samarakoon, Upeka
AU - Hashimoto, Tadayuki
AU - Shirai, Nanako
AU - Davis, Aretha D.
AU - Goldstein, Nathan E.
AU - Garde, Cynthia
AU - Paasche-Orlow, Gabriel A.
AU - Sciacca, Kate
AU - Klein, Karina
AU - Hanson, Eric
AU - Sage, Allyson
AU - Nielsen, Donovan S.
AU - Walker-Corkery, Beth
AU - El-Jawahri, Areej
AU - Barry, Michael J.
AU - Joel, Milton
AU - Platts-Mills, Timothy
AU - Durieux, Brigitte N.
AU - Kwok, Anne
AU - Tyler, Katren R.
AU - Ouchi, Kei
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Society of General Internal Medicine 2026.
PY - 2026
Y1 - 2026
N2 - Background: Advance care planning (ACP) is widely promoted; however, it remains unclear if documentation translates to goal-concordant care aligned with patient values. Objective: To determine whether emergency department-initiated video-enhanced ACP increases documentation and improves goal-concordant care among decedents. Design: Multicenter, parallel-group randomized trial (2022–2024, follow-up to 2025). Outcome assessors were blinded to assignment. Setting: Three emergency departments. Participants: Adults aged ≥ 65 or 50–64 with serious illness. Interventions: Intervention group (a) viewed an ACP video, (b) had an ACP conversation, and (c) triggered electronic health record provider notification. Controls received usual care. Main Measures: Primary outcome was ACP documentation within 3 months. Secondary outcomes included goals-of-care preferences, ACP knowledge (1–5), engagement (1–4), and documentation at 6 months. Goal concordance used a 10-point scale (10 = perfect concordance). Key Results: 598 patients (298 intervention, 300 control; mean age 73.5 ± 8.1 years; 53.7% women) were randomized. At 3 months, ACP documentation was significantly higher in the intervention group (45.6% [136/298] vs. 31.3% [94/300]; rate difference [RD] = 14.3%, 95% CI 6.6%-22.0%; P <.001), persisting at 6 months (52.3% vs. 39.3%; RD = 13.0%, 95% CI 5.1%-20.9%; P =.002). ACP knowledge (4.1 vs. 3.1; mean difference [MD] = 1.0, 95% CI 0.9–1.2; P <.001) and engagement (4.1 vs. 3.9; MD = 0.2, 95% CI 0.1–0.3; P =.004) were greater in the intervention group compared to the control. There were no differences in goals-of-care preferences between the two study arms. Among 94 decedents (53 intervention, 41 control), intervention recipients had substantially higher goal-concordance scores (median 10 [IQR 8–10] vs. 7 [IQR 3–10]; P <.001). Conclusions: Video-enhanced ACP increased documentation rates. Among decedents, goal-concordance was higher in the intervention group, suggesting ED-initiated ACP may help align care with patient preferences. Trial Registration: Clinicaltrials.gov identifier: NCT04931797 (posted June 1, 2021).
AB - Background: Advance care planning (ACP) is widely promoted; however, it remains unclear if documentation translates to goal-concordant care aligned with patient values. Objective: To determine whether emergency department-initiated video-enhanced ACP increases documentation and improves goal-concordant care among decedents. Design: Multicenter, parallel-group randomized trial (2022–2024, follow-up to 2025). Outcome assessors were blinded to assignment. Setting: Three emergency departments. Participants: Adults aged ≥ 65 or 50–64 with serious illness. Interventions: Intervention group (a) viewed an ACP video, (b) had an ACP conversation, and (c) triggered electronic health record provider notification. Controls received usual care. Main Measures: Primary outcome was ACP documentation within 3 months. Secondary outcomes included goals-of-care preferences, ACP knowledge (1–5), engagement (1–4), and documentation at 6 months. Goal concordance used a 10-point scale (10 = perfect concordance). Key Results: 598 patients (298 intervention, 300 control; mean age 73.5 ± 8.1 years; 53.7% women) were randomized. At 3 months, ACP documentation was significantly higher in the intervention group (45.6% [136/298] vs. 31.3% [94/300]; rate difference [RD] = 14.3%, 95% CI 6.6%-22.0%; P <.001), persisting at 6 months (52.3% vs. 39.3%; RD = 13.0%, 95% CI 5.1%-20.9%; P =.002). ACP knowledge (4.1 vs. 3.1; mean difference [MD] = 1.0, 95% CI 0.9–1.2; P <.001) and engagement (4.1 vs. 3.9; MD = 0.2, 95% CI 0.1–0.3; P =.004) were greater in the intervention group compared to the control. There were no differences in goals-of-care preferences between the two study arms. Among 94 decedents (53 intervention, 41 control), intervention recipients had substantially higher goal-concordance scores (median 10 [IQR 8–10] vs. 7 [IQR 3–10]; P <.001). Conclusions: Video-enhanced ACP increased documentation rates. Among decedents, goal-concordance was higher in the intervention group, suggesting ED-initiated ACP may help align care with patient preferences. Trial Registration: Clinicaltrials.gov identifier: NCT04931797 (posted June 1, 2021).
KW - advance care planning
KW - decision aids
KW - emergency medicine
KW - geriatrics
KW - goal-concordant care
KW - goals of care
KW - palliative care
KW - serious illness conversations
KW - shared decision making
KW - video decision aids
UR - https://www.scopus.com/pages/publications/105035874321
U2 - 10.1007/s11606-026-10406-6
DO - 10.1007/s11606-026-10406-6
M3 - Article
AN - SCOPUS:105035874321
SN - 0884-8734
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
ER -