# Randomized Trial of a Home-Advance Care Planning Video Intervention for Patients with Life-limiting Illness

> **NIH NIH R01** · MASSACHUSETTS GENERAL HOSPITAL · 2020 · $399,979

## Abstract

PROJECT SUMMARY/ABSTRACT
Overview: The goal of this study is to demonstrate the effectiveness of a home-based advance care planning
(ACP) video intervention for improving ACP conversations, resuscitation preference documentation, hospice
utilization, and reducing cost of care for patients with life-limiting illness receiving care in the home setting.
Background: The number of patients living with serious chronic illness and receiving home-based care through
Medicare's House Call Providers program is increasing. Often, these patients lack exposure to specialty palliative
care and too frequently receive inpatient palliative care consultations late in the illness trajectory. A large portion
of these inpatient specialty palliative care consults are focused exclusively to support ACP documentation, and
addressing end-of-life (EOL) care needs for this population. Health care systems require evidence-based ap-
proaches that promote these focused palliative care services at home while surmounting challenges such as
palliative care workforce shortage. We have developed a video-assisted, home-based ACP intervention (Home-
ACP) to improve patient-clinician communication, increase ACP documentation, and lead to more patient-cen-
tered and less costly care at the EOL. Home-ACP combines two evidence-based features including 1) predictive
analytics to identify patients with an advanced serious illness and a projected prognosis of one year or less; and
2) ACP video decision aid delivered by a nurse as part of Clover Health's House Call Provider program. Our
prior work has shown the efficacy of ACP videos in several randomized trials, but have not examined their effect
in the home setting. The video is available in 25 languages and scripted at a low literacy level.
Research Plan: We propose to conduct a randomized clinical trial of the Home-ACP intervention versus usual
care in 500 patients with life-limiting illness and a prognosis of one year or less, receiving home-based care. We
will assess the effectiveness of the Home-ACP intervention for preferences for resuscitation, ACP documenta-
tion, and hospice utilization. We will also compare patient-reported outcomes in a subset of 200 patients including
ACP knowledge, confidence in future care, communication satisfaction, and decisional certainty. Lastly, we will
compare the cost of care in the last year of life for patients receiving the Home-ACP intervention versus usual
care.
Environment: This project will be conducted with the support of the Clover Health House Call Providers pro-
gram, which has the resources, infrastructure, and electronic health record capabilities to ensure the success of
this trial. Patients will be recruited from 17 counties in New Jersey with substantial ethnic and racial diversity.
The investigative research team has the expertise in developing and testing video decision aids and palliative
care interventions in large multi-site national trials.
Relevance of Research: This project wil...

## Key facts

- **NIH application ID:** 10028263
- **Project number:** 1R01NR019274-01
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Areej El-Jawahri
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $399,979
- **Award type:** 1
- **Project period:** 2020-09-03 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10028263

## Citation

> US National Institutes of Health, RePORTER application 10028263, Randomized Trial of a Home-Advance Care Planning Video Intervention for Patients with Life-limiting Illness (1R01NR019274-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10028263. Licensed CC0.

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