I CAN DO Surgical Advanced Care Planning Trial

Problem and Need for the Study

While advanced care planning (ACP) is recommended within multiple national guidelines, few older patients engage in surgical advanced care planning before undergoing major elective surgeries. Barriers such as clinician and patient discomfort, limited time, and a lack of patient-facing tools to support complex health decisions prevent ACP adoption. This can lead to older adults undergoing treatments that are not consistent with their goals and preferences.

Several evidence-based ACP tools such as PREPARE (developed by the University of California San Francisco) help patients and caregivers communicate their care goals and make informed medical decisions. Despite this, efforts to improve ACP evidence-based tools pre-surgery has not been done. We are interested in incorporating evidence-based ACP tools into the pre-surgery workflow so that patients can be empowered to discuss advanced care planning before surgery. 

Innovation and Impact

The I CAN DO Surgical ACP is a collaboration between the University of California San Francisco (lead site), University of Minnesota, and University of California Irvine. The pragmatic randomized controlled trial will evaluate the effectiveness of incorporating evidence-based ACP tools into the pre-surgery workflow. The trial will focus on patients 65 years or older and patients with serious illness who have been referred for major elective surgery.

This project will assess the impact of three different delivery strategies for surgical advance care planning, each requiring varying amounts of resources:

• Letter only: Patients receive a letter about ACP and accompanying evidence-based ACP tools
• Letter plus reminders: Patients receive a letter about ACP, evidence-based ACP tools, and text/phone reminders
• Comprehensive support: Patients receive a letter about ACP, evidence-based ACP tools, text/phone reminders, and a healthcare navigator to assist with ACP documentation

By using mixed methods to assess patient and surgical care team experiences with these tools, including the use of natural language processing to evaluate ACP notes, this collaborative effort will help older patients receive treatments that fit their goals and values, even when they are unable to make their own medical decisions.