Engaging English- and Spanish-speaking older adults with and without possible cognitive impairment in advance care planning group visits: protocol for the ENgaging in Advance Care Planning Talks (ENACT) randomized controlled trial

Background Advance care planning (ACP) helps patients identify and communicate their preferences for medical care and prepares them for decision-making related to future care. While ACP is recommended for older adults with cognitive impairment, few interventions have been tested in primary care for...

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Veröffentlicht in:Current controlled trials in cardiovascular medicine Jg. 26; H. 1; S. 353 - 26
Hauptverfasser: Farro, Samantha A., Juarez-Colunga, Elizabeth, Patel, Chandni, Bettcher, Brianne M., Haynes, Christine A., Huebschmann, Amy G., Nowels, David, Tietbohl, Caroline K., Shi, Jiayuan, Ritger, Carly, Shanbhag, Prajakta, Resman, Kathleen, Sudore, Rebecca L., Lum, Hillary D.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 25.09.2025
BioMed Central Ltd
Springer Nature B.V
BMC
Schlagworte:
Adults
Advance Care Planning
Advance directives
Age Factors
Aged
Aged, 80 and over
Analysis
Biomedicine
Chronic illnesses
Clinical trials
Cognition
Cognitive ability
Cognitive Dysfunction - diagnosis
Cognitive Dysfunction - psychology
Cognitive Dysfunction - therapy
Cognitive impairment
Decision making
Dementia
Documentation
Education
Electronic health records
Evidence-based medicine
Female
Geriatrics
Group medical visit
Health care
Health Sciences
Humans
Intervention
Language
Male
Medical records
Medicine
Medicine & Public Health
Multicenter Studies as Topic
Older adults
Older people
Patients
Planning
Primary care
Primary Health Care
Randomized Controlled Trials as Topic
Self-efficacy
Statistics for Life Sciences
Study Protocol
Verbal communication
United Kingdom
Spain
Group medical visit
Mixed methods
Advance care planning
Primary care
Older adults
Randomized controlled trial
Implementation
Cognitive impairment
Dementia
ISSN:1745-6215, 1745-6215
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Zusammenfassung:Background Advance care planning (ACP) helps patients identify and communicate their preferences for medical care and prepares them for decision-making related to future care. While ACP is recommended for older adults with cognitive impairment, few interventions have been tested in primary care for this population. The ENACT trial tests the efficacy of the ENgaging in Advance Care planning Talks (ENACT) Group Visits intervention, which engages older adults with and without possible cognitive impairment in group medical visits focused on the ACP process. Methods This two-arm randomized trial compares the efficacy of the ENACT Group Visits intervention arm to a control arm at 6-month follow-up. The trial will enroll at least 480 patients across 8 primary care clinics. Notable inclusion criteria include English or Spanish-speaking, age 70 or older, and no ACP documents in the electronic health record (EHR) in the past 2 years. The Montreal Cognitive Assessment screener will be administered at study enrollment to identify whether the participant has possible cognitive imparment. Participants will be randomized 1:1 to the ENACT Group Visits arm or control arm. The ENACT Group Visits intervention entails two group visits, facilitated by multidisciplinary clinic staff. The control arm entails sending ACP materials via mail. The primary outcome is new documentation of ACP in the EHR at 6-month follow-up, and it will be analyzed using logistic regression with random effects for site. Secondary outcomes include patient-level ACP readiness, decision self-efficacy, and quality of communication. The impact of possible cognitive impairment on ENACT intervention efficacy will be examined. Survival analyses will be used to examine time-to-new ACP documentation. Mixed methods, including multiple qualitative methods, will be used to assess acceptability, feasibility, intervention fidelity, and other implementation outcomes of the ENACT intervention among patients with possible cognitive impairment. Discussion This study will determine the efficacy of the ENACT Group Visits intervention among diverse older adults, including those with possible cognitive impairment, as evidenced by increased documentation of ACP in the medical record. If efficacious, primary care clinics may implement this ACP intervention that leverages peer interactions and goal setting to support a person-centered ACP process. Trial registration Clinicaltrials.gov: NCT05421728 . Registered on 13 June 2022. 
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ISSN:1745-6215
1745-6215
DOI:10.1186/s13063-025-08964-x