I CAN DO Surgical ACP

The goal of the Advanced Care Planning (ACP) study is to encourage patients aged 65 or older, or with serious illness, who are referred for major elective surgery to have advanced care planning. ACP is also a critical way to support older adults in participating actively with clinicians in making real-time, complex medical decisions so that the medical care they receive is aligned with their goals. Our team has designed and tested a theory-based, interactive ACP patient-facing technology solution (PREPARE) based on the new ACP paradigm of preparing people for communication and medical decision-making. The study team hypothesizes that by including PREPARE into the electronic health record (HER)-centric pre-surgery workflow for older adults and including automated reminders, the study team can empower patients and surgical teams to engage in ACP discussions.

Participants will be randomized to Arms: (1) Letter about ACP, PREPARE advanced directive (AD), PREPARE website; (2) Letter, advanced directive (AD), PREPARE plus reminder text/phone messages; (3) Letter, advanced directive (AD,) PREPARE plus reminders plus a healthcare navigator on ACP documentation (discussions and careplans, primary outcome) and patient-reported ACP engagement. Using mixed methods, the study team will assess patients' and surgical care teams' experience with surgery ACP.