Long-Term Outcomes of Advance Care Planning Among Older Adults With Cognitive Impairment and Their Care Partners: Findings From a Randomized Controlled Trial (SHARE)

Background Advance care planning (ACP) is especially important in the context of cognitive impairment. Little is known about long-term effects of ACP on care partners. Aim To determine the sustained effect of facilitated ACP conversations on care partner-reported quality of communication (QoC) about end-of-life (EoL) care and readiness to engage in ACP at 24-months. Design A total of 273 participants were randomized 1:1 to a multicomponent ACP intervention (SHARE) or usual care. ACP was delivered between baseline and 6 months and dyads were followed through 24 months (N = 114). Outcomes included care partner responses to the 7-item QoC instrument and 6-item readiness to engage in ACP instrument. Group differences at 24 months were compared using ANCOVA, adjusting for baseline scores and cognitive impairment. Setting/participants Cognitively impaired older adults age 80+ and family care partners were recruited from 8 primary care clinics. Results Care partners were mostly women (91.2%), average 65.5 years old, and adult children (66.7%) of the patient. 114 (42.8%) care partners completed 24-month assessments; One fifth of patients died within 24 months (n = 61; 22.3%). Caregiver QoC scores at 24 months were similar for intervention and control groups (3.34 vs 3.18; P = 0.92). Similarly, readiness to engage in ACP was comparable for intervention and control groups (26.63 vs 25.64; P = 0.67). Conclusions ACP conversations did not significantly affect QoC or readiness to engage in ACP at 24 months follow-up in this randomized trial. ACP may require an iterative approach for ongoing benefit in this population.