title: Development of Personalized Health Messages to Promote Engagement in Advance Care Planning.
abstract: OBJECTIVE
  To develop and test the acceptability of personalized intervention materials to promote advance care planning (ACP) based on the Transtheoretical Model (TTM), in which readiness to change is a critical organizing construct.
  
  
  METHODS
  Development study creating an expert system delivering TTM-personalized feedback reports and stage-matched brochures with more-general information on ACP and modifications based on participant reviews.
  
  
  METHODS
  Senior centers.
  
  
  METHODS
  Community-living persons aged 65 and older (N = 77).
  
  
  METHODS
  Participant ratings of length, attractiveness, and trustworthiness of and reactions to reports and brochures.
  
  
  RESULTS
  The expert system assessed participants' readiness to engage in each of four ACP behaviors: completion of a living will, naming a health care proxy, communication with loved ones about quality vs quantity of life, and communication with clinicians about quality vs quantity of life. The system also assessed pros and cons of engagement and values and beliefs that influence engagement. The system provided individualized feedback based on the assessment, with brochures providing additional general information. Initial participant review indicating unacceptable length led to revision of feedback reports from full-sentence paragraph format to bulleted format. After review, the majority of participants rated the materials as easy to read, trustworthy, providing new information, making them more comfortable reading about ACP, and increasing interest in participating in ACP.
  
  
  CONCLUSIONS
  Older adults found an expert system individualized feedback report and accompanying brochure to promote ACP engagement to highly acceptable and engaging. Additional research is necessary to examine the effects of these materials on behavior change.
authors.affiliation: Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut.|Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
authors.affiliation: Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island.
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Redding
authors.affiliation: Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Robbins
authors.affiliation: Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Paiva
authors.affiliation: Program on Aging, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: John R
authors.initials: JR
authors.lastname: O'Leary
authors.affiliation: Program on Aging, School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Lynne
authors.initials: L
authors.lastname: Iannone
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003657:Decision Making; D005103:Expert Systems; D005246:Feedback; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008962:Models, Theoretical
keywords: advance care planning; health behavior; intervention development