This study examined whether a computer-based decision aid for advance care planning (ACP) could help improve communication about end-of-life treatment wishes between patients with amyotrophic lateral sclerosis (ALS) and the clinicians who treat them. Prior to patients with ALS engaging in ACP using the decision aid (and completing pre-/post-questionnaires), the ALS clinic team was surveyed about patient wishes for end-of-life care for 3 hypothetical vignettes (12 treatment decisions total). The clinic team was then re-surveyed 3 months after patients had used the decision aid. These responses were then compared with patient responses to the vignettes, and a concordance score calculated for the agreement between patients and the clinic team. For the 44 participants (66% male, 73% married), concordance between patient wishes and the clinic team decisions was signifi cantly higher post-intervention (pre: M=54%, SD=34.3 → post: M=93.2%, SD=10.3; p <.001). Additionally, patients reported high satisfaction with their decisions about end-of-life care (M=26.4, SD = 3.2; 6= lowest satisfaction, 30=highest), low decisional confl ict (M=28.8/80, SD = 8.2), and high satisfaction with the decision aid (M=52.7/60, SD=5.7). Further, patient knowledge regarding ACP increased post-intervention (pre: 47.8% correct responses → post: 66.2%; p <.001) without any adverse effect on patient anxiety or sense of self-determination. These fi ndings suggest that a computer-based decision aid for ACP is well accepted by patients with ALS and that its use can signifi cantly improve clinicians' understanding of patient wishes regarding end-of-life medical care, as well as increase patient knowledge regarding ACP.

The fl uctuating clinical course of congestive heart failure involves recurrent medical crises and readmission rates of ~50% within 6 months following hospital discharge. The consequent focus on acute care measures often results in insuffi cient emphasis on advance care planning (ACP). This pilot study examined whether an interactive computer-based decision aid can effectively address this need by helping individuals with advanced CHF engage in ACP. Adults with advanced congestive heart failure (i.e., Stage 3 or 4) were recruited from a single cardiovascular clinic; screened for cognitive ability, moderate/ severe depression, and ≥8 th grade reading level; and asked to on 19 June

For various cultural and historical reasons, African Americans are less likely than Caucasians to engage in advance care planning (ACP) for healthcare decisions. This pilot study tested whether an interactive computer program could help overcome barriers to effective ACP among African Americans. African American adults were recruited from traditionally Black churches to complete an interactive computer program on ACP, pre-/post-questionnaires, and a follow-up phone interview. Participants were screened for cognitive ability, moderate/severe depression, and ≥8thgrade reading level. Eighteen adults (mean age = 53.2 years, 83% female) completed the program without any problems. Most participants (14/18) reported knowing “almost nothing” or “a little” about ACP prior to the study, and only 2 participants reported having previously created an advance directive. Knowledge about ACP significantly increased following the computer intervention (44.9% → 61.3%, p = 0.0004), as did individuals' sense of self-determination. Participants were highly satisfied with the ACP process (9.4; 1 = not at all satisfied, 10 = extremely satisfied), and reported that the computer-generated advance directive accurately reflected their wishes (6.4; 1 = not at all accurate, 7 = extremely accurate). Follow-up phone interviews found that most participants reported having shared their advance directives with family members (88%) and spokespeople (82%). Preliminary evidence suggests that an interactive computer program can help African Americans engage in effective advance care planning, including creating an accurate advance directive document that will be shared with loved ones.

Most physicians report that their medical training inadequately prepared them to help patients engage in advance care planning (ACP). This study examined the experience of medical students who used an online decision aid as a tool for assisting individuals through the process of ACP and creating a personalised advance directive. As part of a required unit on “doctoring,” third-year medical students at a single institution helped another adult complete an advance directive using an online decision aid for ACP. They then wrote an essay describing their experience with this exercise. Investigators coded 64 student essays and identified four common themes: 1) Challenges for students completing this exercise; 2) Challenges for the individuals engaging in ACP; 3) Recommendations for implementing ACP in practice; and 4) Feedback on the decision aid. Most students reported the exercise to be valuable, and many reported having learned a great deal about not only the complexity of ACP, but also the challenges of accurately predicting as well as documenting and interpreting another person's values and wishes. Students provided several recommendations for improving the online decision aid, but were generally very pleased with its ease of use, helpfulness in explaining complex ACP issues, and accuracy in helping articulate and document an individual's wishes for future medical care. This study suggests that an online decision aid can help prepare physicians in training to engage in ACP with patients.

Because disease diagnosis and prognosis affect the decisions that patients make when creating advance directives, an understanding of one's diagnosis is important for successful advance care planning. Yet often there exists a wide disparity between physician and patient understanding of the patient's disease, making the goal of shared decision-making difficult to achieve. This study examined the extent to which patients with advanced cancer agree with their physicians regarding their cancer diagnoses prior to engaging in advance care planning and explored variables that might correlate with the degree of patient-physician concordance. 150 patients with a diagnosis of cancer and life expectancy of 1-2 years or less completed a questionnaire on their diagnosis before they engaged in creation of an advanced directive. The physician-designated diagnosis was identified for each patient via chart-review. Patient-physician agreement on diagnosis was coded and concordance rates were expressed in percentages. The majority of patients (62.2%) were in exact concordance with their physicians regarding their diagnosis; 24.3% were in partial agreement, with the patient missing part of the diagnosis; 9.5% were in partial agreement, with the physician missing part of the patient-reported diagnosis; and only 4.1% did not agree with their physicians on diagnosis. No correlation was found between patient-physician concordance rates and age, education level, or comfort with computers; nor was a higher degrees of concordance correlated with having received radiation therapy, which might have been expected due to the greater number of hospital visits and opportunities for reinforcement of information.