Trial Design and Oversight
We conducted the pragmatic, multicenter, stepped-wedge cluster randomized Video Inspired Discussions to Improve Ethical Outcomes with Palliative Care Educators (VIDEO-PCE) clinical trial (According to the stepped-wedge cluster randomized clinical trial design, each inpatient unit (cluster) began in the control phase and transitioned to the intervention phase at a randomly assigned time (wedge). Seven inpatient units were included from each of the 2 urban sites: Boston Medical Center (Boston, Massachussets) and North Shore University Hospital (Manhasset, New York). To promote covariate balance, prior to the start of data collection, each hospital unit to be included in the trial at Boston Medical Center was paired based on size and function with a matched unit at North Shore University Hospital to create 7 paired clusters. A set of uniform random numbers was generated and used to assign the order of paired clusters for intervention initiation. Following a 2-month baseline period in which no units were exposed to the intervention, a new paired cluster was exposed to the intervention every 2 months (eTable 1 in 