Project Summary: Reducing Racial Disparities in Advance Care Planning within Neuro-Oncology The Agency for Healthcare Quality and Research has called for research that improves care planning in racial/ethnic minorities as well as priority patient populations, which includes those who require end-of-life care. Advance care planning (ACP) involves discussion and documentation of patients’ goals and is unfortunately poorly executed for patients from racial and ethnic minority backgrounds. ACP is also especially important in neuro-oncology, as patients have poor prognoses and often suffer from progressive cognitive decline interfering with decision-making capacity. The proposed project’s central hypothesis is that identifying the racial and cultural barriers to implementing timely ACP will enhance goal-concordant care in terminal neuro- oncologic disease and reduce racial and ethnic disparities in end-of-life care. The rationale is that timely ACP is a key component of goal-concordant care delivery for neuro-oncologic patients. This proposal will utilize rigorous quantitative and qualitative research methods to answer the following innovative Aims: 1) to define current ACP implementation patterns within a tertiary-care health system and analyze patient-level factors contributing to the existing timing and content of ACP; 2) to identify patient- and provider-specific attitudes, barriers and other factors involved in ACP implementation; and 3) to identify the most feasible and practically implementable strategy available for addressing challenges and reducing disparities in ACP implementation in the neuro-oncologic patient population. Dr. Adela Wu is a neurosurgery resident physician at Stanford interested in improving end-of-life care for neuro-oncologic and neurosurgical patients. She seeks to receive rigorous training in quantitative and qualitative research design, methodology, and planning necessary to become an independent surgeon-scientist and a leader in neurosurgical oncology and palliative care with K award and other career development funding. Under the close supervision of the mentorship team led by nationally-renowned experts in palliative care and implementation science (Dr. Karl Lorenz), palliative care and patient-centered outcomes (Dr. Rebecca Aslakson), biomedical ethics and communication (Dr. David Magnus) and neuro-oncology management (Dr. Michael Lim), Dr. Wu will achieve the proposed research Aims. The training plan includes regular mentorship meetings, formal didactic courses, and seminars to deepen understanding of core research skills Dr. Wu will need to earn further career development funding and become a successful, independent investigator. Furthermore, Stanford University is a highly regarded center for biomedical research, with the oldest palliative care fellowship program nationwide, t he Stanford Palliative Care Center of Excellence, and a clinically busy neuro-oncology service and outpatient clinic at the Stanford Cance...