title: Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations.
abstract: OBJECTIVE
  Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care-based group visit model focused on advance care planning.
  
  
  METHODS
  We conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project.
  
  
  RESULTS
  Ten of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics.
  
  
  CONCLUSIONS
  A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado Hillary.Lum@ucdenver.edu.
authors.forename: Hillary D
authors.initials: HD
authors.lastname: Lum
authors.affiliation: College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
authors.affiliation: VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Lobo
authors.affiliation: Denver-Seattle Center for Veteran-centered and Value-Driven Care, Denver, Colorado.
authors.forename: Cari R
authors.initials: CR
authors.lastname: Levy
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Schwartz
authors.affiliation: University of California, San Francisco Division of Geriatrics, VA Medical Center, University of California, San Francisco, California.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Sudore
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D003120:Colorado; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D010358:Patient Participation; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D036301:Qualitative Research; D012017:Referral and Consultation
keywords: advance care planning; group medical visits; patient engagement