# Effectiveness of Engaging in Advance Care Planning Talks (ENACT) Group Visits Intervention in Primary Care for Older Adults with and without Alzheimer's Dementia

> **NIH NIH R01** · UNIVERSITY OF COLORADO DENVER · 2021 · $780,725

## Abstract

PROJECT SUMMARY
Individuals living with Alzheimer's Disease and Related dementias (ADRD) may experience unwanted,
intensive or burdensome end-of-life care because their preferences for care are unknown to their medical
decision makers. For example, nearly 41% of individuals with ADRD undergo at least one intensive
intervention (e.g., mechanical ventilation, artificial nutrition) in the last 3 months of life, which may prolong life
but does not address quality of life. Thus, timely discussions about advance care planning (ACP) are
imperative before individuals with dementia lose decision making capacity. Persons with cognitive impairment,
spanning from mild cognitive impairment to dementia, are often cared for in primary care. However, primary
care settings do not have effective models that can systematically integrate clinician-patient discussions and
decision-making about ACP for older adults with and without cognitive impairment who still have decision
making capacity. To address these gaps, we designed, refined with stakeholder input, and demonstrated the
feasibility, acceptability, and efficacy of a theory-based and practical ACP group visit intervention, ENACT
Group Visits (Engaging in Advance Care Planning Talks) among older primary care patients. ENACT Group
Visits are two facilitated discussions, one month apart, led by a physician or advanced practice provider and a
social worker. The intervention uses evidence-based ACP materials and leverages the group dynamic to
promote patient goal-setting and self-efficacy. In a single-clinic pilot study, patients randomized to the ENACT
Group Visits intervention had a 26% higher rate of ACP documents at 6 months, compared to a control arm of
mailed ACP materials (p=0.007). This study aims to test the effectiveness of ENACT Group Visits to increase
ACP documentation (one aspect of ACP) and to evaluate its effectiveness among patients across a spectrum
of cognitive impairment, including early dementia. The proposed 2-arm, patient-level randomized trial will be
conducted in five primary care clinics and is powered to compare ENACT Group Visits intervention vs control
mailed ACP materials. We will use 1:1 allotment and patient-level block randomization by presence or absence
of CI. The study will use components of PREPARE™, an evidence-based ACP program designed to decrease
cognitive burden, and an easy-to-read advance directive. Aim 1 will determine the effectiveness of ENACT
Group Visits vs control at 6 months to increase ACP documentation (primary outcome), ACP readiness,
decision self-efficacy, and quality of communication (secondary outcomes). Aim 2 will determine whether the
effectiveness of ENACT Group Visits intervention varies by cognitive impairment, including ADRD. Aim 3 will
describe acceptability and feasibility, as well as intervention fidelity and implementation outcomes, of ENACT
Group Visits intervention using qualitative and mixed methods. This primary care-based effectiveness trial o...

## Key facts

- **NIH application ID:** 10100456
- **Project number:** 1R01AG066804-01A1
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** Hillary Lum
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $780,725
- **Award type:** 1
- **Project period:** 2021-03-15 → 2026-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10100456

## Citation

> US National Institutes of Health, RePORTER application 10100456, Effectiveness of Engaging in Advance Care Planning Talks (ENACT) Group Visits Intervention in Primary Care for Older Adults with and without Alzheimer's Dementia (1R01AG066804-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10100456. Licensed CC0.

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