Practice Variability in the SHARING Choices Pragmatic Trial of Primary Care Advance Care Planning.
Background: Barriers to advance care planning intervention implementation and impact on outcomes at the patient, clinician, and health system levels are well‐documented. Understanding practice‐level variation in implementation and outcomes could elucidate relevant contextual factors and potential st...
| Publicado en: | Journal of the American Geriatrics Society Vol. 74; no. 4; pp. 1033 - 1041 |
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| Autores principales: | , , , , , , , |
| Formato: | Artículo |
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Wiley-Blackwell
Apr2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=193014272&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 193014272 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Apr2026 vid: 74 iid: 4 pid: 480 pub: Wiley-Blackwell artinfo: ui: 193014272 10.1111/jgs.70341 ppf: 1033 ppct: 8 formats: tig: atl: Practice Variability in the SHARING Choices Pragmatic Trial of Primary Care Advance Care Planning. aug: au: Dy, Sydney M. Scerpella, Danny Wolff, Jennifer L. Abshire Saylor, Martha Giovannetti, Erin R. Hanna, Valecia Colburn, Jessica L. Roth, David L. affil: Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland,, USA Department of Medicine, Johns Hopkins School of Medicine, Baltimore Maryland,, USA Johns Hopkins University School of Nursing, Baltimore Maryland,, USA MedStar Health System, Baltimore Maryland,, USA su: Health services accessibility Corporate culture Qualitative research Interprofessional relations Primary health care Interviewing Quantitative research Communication Terminal care Advance directives (Medical care) Pearson correlation (Statistics) Secondary analysis Research funding Odds ratio Thematic analysis Physician practice patterns Research methodology Attitudes of medical personnel Electronic health records Data analysis software sug: subj: Health services accessibility Corporate culture Qualitative research Interprofessional relations Primary health care Interviewing Quantitative research Communication Terminal care Advance directives (Medical care) Pearson correlation (Statistics) Secondary analysis Research funding Odds ratio Thematic analysis Physician practice patterns Research methodology Attitudes of medical personnel Electronic health records Data analysis software keyword: advance care planning mixed‐methods pragmatic trial primary care advance care planning mixed‐methods pragmatic trial primary care ab: Background: Barriers to advance care planning intervention implementation and impact on outcomes at the patient, clinician, and health system levels are well‐documented. Understanding practice‐level variation in implementation and outcomes could elucidate relevant contextual factors and potential strategies for improving future implementation. We therefore examined practice variation and associations between processes and outcomes in the pragmatic trial of SHARING Choices, a primary care advance care planning (ACP) and communication intervention for older adults. Methods: We conducted an explanatory sequential mixed‐methods analysis of quantitative variation among intervention practices in trial processes and outcomes, and qualitative interview analysis of ACP facilitators' perceptions of variation in implementation. We evaluated variation in key processes: (1) reach (phone contact between ACP facilitator and patient/family) and (2) uptake (facilitator‐led ACP conversations) and outcomes: (1) new electronic health record (EHR)‐documented advance directives (ADs) at 12 months and (2) receipt of potentially burdensome care within 6 months of death for Maryland residents with serious illness who died. We examined practice‐level correlations among processes and outcomes. Results: Variation among practices was substantial for key processes (ACP facilitator reach and uptake) and outcomes (new EHR AD documentation and potentially burdensome care at end of life; all p < 0.01). Processes of reach and uptake were significantly correlated with the outcome of new EHR AD documentation but not with potentially burdensome care at end of life. ACP facilitators perceived variation in practice engagement with the intervention related to practice relationships and teams, relative priority of ACP, and resources such as space. Conclusions: Practice variation in processes and mixed associations with outcomes highlight pragmatic trial implementation challenges and the impact and complexity of ACP. Future ACP trials should consider accounting for and evaluating practice variation in study design, implementation, and analysis. Summary: Key points ○Variation among practices was substantial for key processes and outcomes in this pragmatic trial of advance care planning (ACP).○Processes were significantly correlated with the outcome of new electronic health record advance directive documentation, but not with potentially burdensome care at end of life.○These findings highlight challenges of pragmatic trial implementation and impact, and the complexity of ACP implementation.Why does this paper matter? ○Evaluating practice variation may inform ACP implementation and understanding results of pragmatic trials of complex interventions. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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