Discussion
ADRD
AIDS
In this pragmatic, stepped-wedge cluster randomized clinical trial that included a racially and ethnically diverse population, an intervention in which PCEs shared decision-making video decision aids and facilitated GOC communication increased the proportion of hospitalized patients with GOC documentation. Video use was robust for patients seen by PCEs, demonstrating successful implementation. The intervention was also associated with increased GOC documentation for Black or African American individuals, Hispanic or Latino individuals, non-English speakers, and patients living with ADRD.Providing optimal serious illness care involves understanding patient values, goals, and preferences. For many medical decisions, there often is not a clear superior path for treatment and multiple reasonable options exist that require engaging patient values and preferences.The VIDEO-PCE trial leveraged a proactive model in which PCEs engaged all patients aged 65 years or older in GOC communication by providing them with videos that raise patients’ awareness and understanding of treatment options and possible outcomes.A key finding of the trial was increased GOC documentation across each racial and ethnic group. Prior research suggests that Black or African American and Hispanic or Latino individuals are less likely to engage or be engaged in GOC conversations.Notably, the intervention increased GOC documentation for English and non-English speakers as well as for persons living with ADRD. The videos were available in 29 languages, 19.4% of videos viewed were in languages other than English, and 17.5% of the videos viewed were related to caregiving for a person with ADRD. Engaging non-English speakers with videos in a patient’s or caregiver’s preferred language and sharing ADRD-specific videos via text or email with caregivers of persons living with ADRD who were often remote allowed for patients and caregivers to be meaningfully engaged in a shared decision-making discussion.It is notable that the VIDEO-PCE model not only increased GOC documentation rates overall but also did so among groups that are least likely to have documented shared decision-making conversations. While the intervention improved GOC documentation in all groups, it did not narrow underlying racial and ethnic disparities. More research is needed to identify opportunities to ameliorate racial and ethnic disparities in GOC decision-making.