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Cited by 12Palliative Care and End-of-Life IssuesElectronic Health Records SystemsPalliative and Oncologic Care

Improving communication about goals of care for hospitalized patients with serious illness: study protocol for two complementary randomized trials

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Curtis, J. Randall, Lee, Robert Y., Brumback, Lyndia C., Kross, Erin K., Downey, Lois, Torrence, Janaki, Heywood, Joanna, LeDuc, Nicole +6 more·2022·Contemporary Clinical Trials
DOI 10.1016/j.cct.2022.106879PMC PMC10042145
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Abstract

Background Although goals-of-care discussions are important for high-quality palliative care, this communication is often lacking for hospitalized older patients with serious illness. Electronic health records (EHR) provide an opportunity to identify patients who might benefit from these discussions and promote their occurrence, yet prior interventions using the EHR for this purpose are limited. We designed two complementary yet independent randomized trials to examine effectiveness of a communication-priming intervention (Jumpstart) for hospitalized older adults with serious illness.Methods We report the protocol for these 2 randomized trials. Trial 1 has two arms, usual care and a clinician-facing Jumpstart, and is a pragmatic trial assessing outcomes with the EHR only (n = 2000). Trial 2 has three arms: usual care, clinician-facing Jumpstart, and clinician- and patient-facing (bi-directional) Jumpstart (n = 600). We hypothesize the clinician-facing Jumpstart will improve outcomes over usual care and the bi-directional Jumpstart will improve outcomes over the clinician-facing Jumpstart and usual care. We use a hybrid effectiveness-implementation design to examine implementation barriers and facilitators.Outcomes For both trials, the primary outcome is EHR documentation of a goals-of-care discussion within 30 days of randomization; additional outcomes include intensity of end-of-life care. Trial 2 also examines patient- or family-reported outcomes assessed by surveys targeting 3-5 days and 4-8 weeks after randomization including quality of goals-of-care communication, receipt of goal-concordant care, and psychological symptoms.Conclusions This novel study incorporates two complementary randomized trials and a hybrid effectiveness-implementation approach to improve the quality and value of care for hospitalized older adults with serious illness.Clinical trials registration STUDY00007031-A and STUDY00007031-B.

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  • The interventions tested in all three trials did not alter existing clinician EHR documentation processes or templates for documentation of goals-of-care discussions.

    “The interventions tested in all three trials (variants of the Jumpstart Guide) did not alter existing clinician EHR documentation processes or templates for documentation of goals-of-care discussions.21,28,29”

    From Assessment of a Zero-Shot Large Language Model in Measuring Documented Goals-of-Care Discussions (2026) · cites this paper as [29]

    The Introduction describes two trials, not all three trials named in the citing sentence. Methods > Interventions says the Jumpstart Guides are delivered to clinicians by secure email, page alert, or in person, and that EHR notes are used to measure documentation. This is consistent with leaving documentation practices unchanged, but the paper does not state that existing clinician EHR documentation processes or templates were unaltered; no page numbers are available in our copy. (LLM, conf=0.78)

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Research works printed but not linked: 1

  1. [94]Giacomini M, Cook DJ, For the evidence-based medicine working group. Qualitative research in health care: what are the results and how do they help me care for my patients? JAMA 284 (2000) 478– 482. 10904512

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Authors
Curtis, J. R., Lee, R. Y., Brumback, L. C., Kross, E. K., Downey, L., Torrence, J., Heywood, J., LeDuc, N., Mallon Andrews, K., Im, J., Weiner, B. J., Khandelwal, N., Abedini, N. C., & Engelberg, R. A.
Affiliations
University of Washington (US)
Corresponding author
Curtis, J. Randall
ORCID
Venue
Contemporary Clinical Trials
Publisher
Elsevier BV
Published
2022-09
Volume
120
Pages
106879
ISSN
1551-7144 (ISSN-L)
DOI
10.1016/j.cct.2022.106879
PMC
PMC10042145
OpenAlex
W4291397892
Cited by
12
References
94
Citations by year
2026: 4 · 2025: 5 · 2023: 2 · 2022: 1
FWCI
1.77
Type
journal article
Language
en
Update notices
erratum (2025-07-01)
Open access
Licence
Locations
  • Contemporary Clinical Trials (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
goals of care discussions, hospitalized older adults, serious illness, electronic health records, two-way communication, palliative care, goal-concordant care, implementation barriers and facilitators
MeSH terms
Aged, Communication, Humans, Palliative Care, Patient Care Planning, Terminal Care, Randomized Controlled Trials as Topic, Pragmatic Clinical Trials as Topic

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