# Promoting Advance Care Planning as a Healthy Behavior

> **NIH VA I01** · VA CONNECTICUT HEALTHCARE SYSTEM · 2020 · —

## Abstract

The recent Institute of Medicine report “Dying in America: Improving Quality and Honoring Individual
Preferences near the End of Life” endorses advance care planning (ACP) as a key component of quality
healthcare. In contrast to the prevailing model of engaging only individuals with serious illness in ACP, it
proposes a continuous process, starting earlier in the lifespan with individuals in good health. Such an
approach helps to prepare the individual for more in-depth discussions and treatment decision making as more
serious illness develops. This project is responsive to this call. It builds upon earlier work of the Principal
Investigator (PI) providing two key insights for improving the process of ACP. The first of these is shifting the
purpose of ACP away from the pre-specification of treatment preferences to preparation for making the best
possible “in-the-moment” healthcare decisions. This is accomplished by conceptualizing ACP as acts of
communication among patients, surrogates, and clinicians. The second is explicitly addressing the many
attitudinal, cognitive, and behavioral barriers to engagement in ACP. This is accomplished by treating ACP as
a health behavior and intervening using validated models for health behavior change. The PI has developed
and pilot-tested an intervention based on the Trans-Theoretical Model. This intervention consists of an expert
system that assesses an individual's readiness to engage in ACP along with the attitudes and beliefs
influencing the desire, motivation, and ability to engage. It then provides individually tailored feedback
materials providing information, motivation, and/or behavior change strategies (computer-tailored information
or CTI). This project will also utilize a form of motivational interviewing called motivational enhancement
therapy (MET), which, while also including the concept of readiness for behavior change, is distinct from CTI. It
consists of brief counseling exploring an individual's readiness to engage in behavior change and helping the
individual to identify motivators for change.
 The objective of the project is to examine the effects of CTI and MET on Veteran engagement in ACP. The
specific aim is: To conduct a randomized controlled trial examining the effects of: a) usual care; b) CTI; c)
MET; d) CTI + MET on the proportion of middle-age and older Veterans receiving primary care at the VA who
complete the process of ACP. Broad eligibility criteria will be used to identify Veterans age 55 years and older
who are receiving primary care within VA Connecticut Healthcare System and who have not completed all of
the 4 key ACP behaviors: health care proxy assignment, living will completion, communication with the health
care proxy about views on quality vs. quantity of life, communication with the clinician about these views. The
intervention(s) will be delivered over the phone. For Veterans receiving CTI, an individually tailored feedback
report, a stage-matched brochure, and a pa...

## Key facts

- **NIH application ID:** 10018500
- **Project number:** 5I01HX002062-02
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** Terri R. Fried
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-05-01 → 2021-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10018500

## Citation

> US National Institutes of Health, RePORTER application 10018500, Promoting Advance Care Planning as a Healthy Behavior (5I01HX002062-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10018500. Licensed CC0.

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