Randomization Flowchart
death
SIC indicates serious illness conversation.Primary outcomes at 40 weeks (after 16 weeks of rollout and 24 weeks of follow-up) included SIC rates for all, high-risk, and non–high-risk patients, along with subgroup analyses stratified by age, self-reported race and ethnicity, sex, insurance status, and clinic type. A specific type of note indicated SICs in the advance care planning module of the electronic medical record. End-of-life outcomes included inpatient death, intensive care unit use within 30 days of death, systemic therapy (chemotherapy or checkpoint inhibitor therapy) within 14 days of death, hospice enrollment prior to death, and hospice length of stay.