Feasibility of Using Simulation to Evaluate Implementation Fidelity in an Advance Care Planning Pragmatic Trial.

Traditional methods of fidelity monitoring are not possible in pragmatic trials in real-world clinical settings. We describe our approach to monitoring and reinforcing the fidelity to ACP conversations for a hard-to-reach subpopulation by using standardized patients in a pragmatic trial. We developed standardized patient scenarios grounded in the Respecting Choices First Steps™ Advance Care Planning curriculum to provide an opportunity to reinforce and assess ACP facilitator competency.

Qualitative evaluation of the SHARING Choices trial of primary care advance care planning for adults with and without dementia.

Background: Primary care can be an important setting for communication and advance care planning (ACP), including for those with dementia and their families. The study objective was to explore experiences with a pragmatic trial of a communication and ACP intervention, SHARING Choices, in primary care for older adults with and without dementia.

Methods: We conducted qualitative interviews using tailored semi-structured guides with three groups: ACP facilitators who conducted the intervention; clinicians, managers, and administrators from sites randomized to the intervention; and patients and families who met with ACP facilitators.

SHARING Choices: Lessons Learned from a Primary-Care Focused Advance Care Planning Intervention.

Background: Few advance care planning (ACP) interventions have been scaled in primary care.

Problem: Best practices for delivering ACP at scale in primary care do not exist and prior efforts have excluded older adults with Alzheimer's Disease and Related Dementias (ADRD).

Intervention: SHARING Choices (NCT#04819191) is a multicomponent cluster-randomized pragmatic trial conducted at 55 primary care practices from two care delivery systems in the Mid-Atlantic region of the U.

SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care.

Background: Advance care planning (ACP) and involving family are particularly important in dementia, and primary care is a key setting. The purpose of this trial is to examine the impact and implementation of SHARING Choices, an intervention to improve communication for older adults with and without dementia through proactively supporting ACP and family engagement in primary care.

Methods: We cluster-randomized 55 diverse primary care practices across two health systems to the intervention or usual care.

Evidence-based Non-pharmacologic Interventions for Managing Neuropsychiatric Symptoms and Mental Health Issues in Residents in Assisted Living.

The Problem: Mental health issues such as depression and neuropsychiatric symptoms (NPS) (e.g. agitation, aggression, rejection of care, wandering) are prevalent among residents in Assisted Living Facilities (ALF).