The following is the summary of “Effect of Computer-Tailored Print Feedback, Motivational Interviewing, and Motivational Enhancement Therapy on Engagement in Advance Care Planning” published in the November 2022 issue of Internal medicine by Fried, et al.


Clinician-led approaches to engagement in advance care planning (ACP) are effective but resource-intensive, while self-administered tools are more widely disseminated but rely on the capacity and willingness of the patient to complete.  Comparing computer-tailored print feedback (CTPF), motivational interviewing (MI), and motivational enhancement treatment (MET) to standard care in terms of completing a set of ACP activities. Between October 2017 and December 2020, primary care patients at a single VA facility participated in a randomized clinical trial via telephone contact. A total of 483 veterans aged 55 or older were randomly selected from a list of patients who had a primary care visit in the previous 12 months, emphasizing oversampling women and people from underrepresented racial and ethnic groups. Statistics were run from January through June of 2022.

The CTPF, MI, and MET were all delivered by telephone at baseline, 2 months, and 4 months to measure preparedness to engage in and attitudes toward ACP, explore ambivalence to change and build a change plan, respectively. The Primary Outcome and Its Metrics At the 6-month mark, the patient has self-reported having completed four ACP activities: discussing values regarding the quality of life versus quantity of life; appointing a health care agent; completing a living will; and submitting documents for inclusion in the electronic health record. The average age of the 483 participants was 68.3 (8.0) years; 18.2% were female; 31.1% were members of racial or ethnic minorities; and 3.1% were not U.S. citizens or permanent residents. 

The projected odds of completing the ACP activities were as follows, after accounting for age, education, race, gender, and baseline stage of change for each ACP: regular medical attention 5.7% (95% CI, 2.8-11.1%) for standard treatment; 17.7% (95% CI, 11.8-25.9%; P=.003) for MET; 15.8% (95% CI, 10.2%-23.6%; P=.01) for MI; and 10.0% (95% CI, 5.9%-16.7%; P=.18) for CTPF. All 3 MI and MET counseling sessions significantly boosted the number of middle-aged and older veterans who finished a set of ACP exercises, but print feedback had no effect on this randomized clinical trial. Based on these results, clinical interaction is crucial for ACP participation.

Source: jamanetwork.com/journals/jamainternalmedicine/article-abstract/2797771