Feasibility of a Video-Based Advance Care Planning Website to Facilitate Group Visits among Diverse Adults from a Safety-Net Health System

J Palliat Med. 2018 Jun;21(6):853-856. doi: 10.1089/jpm.2017.0476. Epub 2018 Feb 20.


Background: Primary care providers in safety-net settings often do not have time to discuss advance care planning (ACP). Group visits (GV) may be an efficient means to provide ACP education.

Objectives: To assess the feasibility and impact of a video-based website to facilitate GVs to engage diverse adults in ACP.

Design: Feasibility pilot among patients who were ≥55 years of age from two primary care clinics in a Northern California safety-net setting. Participants attended two 90-minute GVs and viewed the five steps of the movie version of the PREPARE website ( www.prepareforyourcare.org ) concerning surrogates, values, and discussing wishes in video format. Two clinician facilitators were available to encourage participation.

Measurements: We assessed pre-to-post ACP knowledge, whether participants designated a surrogate or completed an advance directive (AD), and acceptability of GVs and PREPARE materials.

Results: We conducted two GVs with 22 participants. Mean age was 64 years (±7), 55% were women, 73% nonwhite, and 55% had limited literacy. Knowledge improved about surrogate designation (46% correct pre vs. 85% post, p = 0.01) and discussing decisions with others (59% vs. 90%, p = 0.01). Surrogate designation increased (48% vs. 85%, p = 0.01) and there was a trend toward AD completion (9% vs. 24%, p = 0.21). Participants rated the GVs and PREPARE materials a mean of 8 (±3.1) on a 10-point acceptability scale.

Conclusions: Using the PREPARE movie to facilitate ACP GVs for diverse adults in safety net, primary care settings is feasible and shows potential for increasing ACP engagement.

Keywords: advance care planning; group visits; safety net; videos.

MeSH terms

  • Advance Care Planning / organization & administration*
  • Advance Directives*
  • Aged
  • Aged, 80 and over
  • California
  • Decision Making, Computer-Assisted*
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Education as Topic / methods*
  • Primary Health Care / methods*
  • Video Recording*