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Empowering patients with the PREPARE advance care planning program results in reciprocal clinician communication
Open accessAbstract
Background: The patient‐directed PREPAREforYourCare.org program empowers patients to participate in advance care planning (ACP) discussions with clinicians. Our goal was to determine whether PREPARE could reciprocally increase clinician ACP communication. Methods: In a secondary analysis of two trials evaluating the efficacy of PREPARE plus an easy‐to‐read advance directive (AD) versus an AD alone, patients were included if they were ≥55 years old, English‐ or Spanish‐speaking, and had ≥2 chronic conditions. We audio‐recorded postintervention primary care visits and used the validated clinician–patient participation coding scheme to calculate the number of clinician ACP utterances concerning information‐giving, recommendations, or supportive talk. We examined differences by study arm using mixed effects negative binomial models, stratifying by language. To assess possible mediation, we adjusted for active patient participation (e.g., asking questions or stating preferences). Results: Three hundred ninety‐three visits were audio‐recorded (177 in PREPARE arm and 216 in AD‐only arm). Recordings included 179 clinicians (mean 2.2 [SD 1.9] patients each). Patients' mean age was 66 ± 8 years, 31% had limited health literacy, and 25% were Spanish‐speaking. Exactly 67% of recordings included information‐giving, 85% recommendations, and 62% supportive talk. PREPARE resulted in 51% more clinician supportive talk versus the AD alone (mean 4.5 [8.9] vs. 2.9 [6.0] utterances; incidence rate ratio 1.51 [95% CI 1.02–2.24]). Effects were most pronounced among Spanish speakers. There were no differences in information‐giving or recommendations. After adjusting for active patient participation, no differences in supportive talk remained. Conclusions: The patient‐directed PREPARE program was associated with greater clinician supportive ACP communication with older adults compared with an AD alone; the effect was most pronounced among Spanish speakers and was mediated by active patient participation. Thus, PREPARE helps patients be more engaged communicators, which in turn encourages clinicians to be more supportive of patients. Enhanced patient–clinician communication represents an important mechanism by which PREPARE may decrease disparities in ACP.
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Enhancing patient preparedness through pre-visit planning has been associated with improved relationships between patients and HCPs, increased patient empowerment, and active participation in chronic disease self-management.
“Enhancing patient preparedness through pre-visit planning has been associated with improved relationships between patients and HCPs, increased patient empowerment, and active participation in chronic disease self-management [38], all essential for achieving person-centred care [38].”
From Caregiver experiences of an integrative patient-centered digital health application for pediatric type 1 diabetes care: Findings from a pilot clinical trial (2025) · cites this paper as [38]
The Discussion reports that the patient-directed PREPARE program increased active patient participation and clinicians’ supportive communication about advance care planning, which the authors link to patient-centered communication. It does not show that pre-visit planning improved patient–clinician relationships or increased participation in chronic disease self-management; having chronic conditions was an eligibility criterion, not the outcome studied. (LLM, conf=0.86)
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Amed, S., Pinkney, S., Abdulhussein, F. S., Virani, A., Zachariuk, C., Tamana, S. K., Muralidharan, S., Görges, M., Barrett, B., van Rooij, T., et al. (2025) · PLOS Digital Health · doi:10.1371/journal.pdig.0000861 · Cited by 1
“Enhancing patient preparedness through pre-visit planning has been associated with improved relationships between patients and HCPs, increased patient empowerment, and active participation in chronic disease self-management [38], all essential for achieving person-centred care [38].”
Metadata
- Authors
- Nouri, S., Street, R. L., Barnes, D. E., Shi, Y., Volow, A. M., Li, B., Alexander, S. C., & Sudore, R. L.
- Affiliations
- University of California, San Francisco (US)
- Michael E. DeBakey VA Medical Center (US)
- San Francisco VA Medical Center (US)
- Purdue University West Lafayette (US)
- Corresponding author
- Nouri, Sarah
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2021-11-10
- Volume
- 70
- Issue
- 2
- Pages
- 585-591
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC8821241
- OpenAlex
- W3212461285
- Cited by
- 16
- References
- 18
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 5 · 2023: 3
- FWCI
- 1.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (K24AG054415, R01 AG045043)
- Patient-Centered Outcomes Research Institute (CDR‐1306‐01500)
- U.S. Department of Veterans Affairs (#11‐110‐2)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- advance care planning, advance directives, patient-clinician communication, patient participation, Spanish-speaking patients, health literacy, older adults, primary care visits
- MeSH terms
- Aged, Chronic Disease, Communication, Ethnicity, Female, Health Personnel, Humans, Language, Male, Patient Participation, Primary Health Care, Randomized Controlled Trials as Topic, Advance Care Planning, Health Literacy
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