Intervention
ADRD, Alzheimer disease, dementias
AIDS, ALZHEIMER DISEASE
The intervention involved the PCEs facilitating GOC conversations with patients and/or their decision-makers using a library of brief, certified video decision aids that addressed a range of topics (eg, GOC, cardiopulmonary resuscitation, hospice, palliative care, time-limited trials, Alzheimer disease and related dementias [ADRD], and COVID-19). The decision aids are grounded in the theory of shared decision-makingEach morning, a list of eligible patients for intervention units was generated by each site’s clinical data warehouse and provided to the PCEs, who used their clinical judgment to triage which patients they would engage. Newly admitted patients without documented GOC discussions were prioritized over patients with documented GOC recorded prior to the start of the intervention. The PCEs did not engage patients with a documented GOC discussion at admission or those who were receiving palliative care services (eFigure in The engagement of PCEs was proactive; their services were not contingent on a request for consultation from the treating practitioner. The PCEs were able to tailor the encounter and choose which video to use according to the patient’s circumstances or to not use a video for uncomplicated discussions. The PCEs showed videos on a tablet computer but were also able to share videos via text or email for remote caregivers of patients who were incapacitated (eg, patients with ADRD, patients receiving mechanical ventilation) or for patients in isolation (eg, patients with COVID-19).The PCEs saw patients independently, engaging patients with GOC shared decision-making conversations. After interacting with patients, PCEs documented findings in the electronic health record (EHR), coordinated care with the patient’s treating team, and stimulated a palliative care consultation in complex cases.Monthly 1-hour group sessions were conducted with the PCEs throughout the study period by 2 palliative care clinicians (J.R.L. and P.M.R.). These sessions included audit and feedback, education about clinical decision-making, review of difficult cases, and coaching.