# Meeting the Challenges of COVID-19 by Expanding the Reach of Palliative Care: Proactive Advance Care Planning with Videos for the Elderly and all Patients with Dementia

> **NIH NIH R01** · BOSTON MEDICAL CENTER · 2022 · $929,442

## Abstract

The majority of patients aged 65 or over, and patients with Alzheimer's Disease and Related Dementias
(ADRD), have never communicated their preferences to clinicians or completed advance care planning (ACP)
documents. Palliative care has the potential to improve ADRD care, improve patient-clinician communication
and patient-centered outcomes, while decreasing unwanted burdensome treatments and improving care at the
end of life. The novel Coronavirus Disease 2019 (COVID-19) has acutely escalated the importance of
integrating ACP and palliative care services into medical care. The default response to critical illness for
patients with ADRD (and all others) is intubation, mechanical ventilation, and aggressive care despite having
no change in mortality outcome. ADRD patients and their caregivers may prefer to avoid these interventions.
 To address these gaps, we have developed a COVID-19 ACP Educator-led, video-assisted palliative
care intervention to improve patient-clinician communication, increase ACP documentation, and lead
to more patient-centered care at the end of life. We will identify all hospitalized patients aged 65 and older,
and any patient with ADRD, and then an ACP Educator will proactively proceed with primary palliative care
services of ACP, leveraging certified video decision aids that we have developed. The ACP Educator to be
tested in this proposal represents a new role and proactive function for the palliative care team. The ACP
Educator, who will be a palliative care nurse, will work with older patients or patients with ADRD and proxy
decision-makers to learn about and document patients' wishes.
 The overall objective is to reduce the burden of COVID-19 by expanding the reach of inpatient palliative
care, especially for patients with ADRD. We propose to conduct a stepped wedge cluster randomized trial of
an ACP Educator intervention among hospitalized patients aged 65 and over, or any patient with ADRD and
their proxy decision-makers in the ward and ICU settings of two major hospitals: Boston Medical Center and
North Shore University Hospital. Patient outcomes will be abstracted from electronic health records with
Natural Language Processing. We will evaluate intervention effectiveness by comparing the following
outcomes among 9,000 hospitalized patients: ACP documentation; preferences for resuscitation; palliative care
consults; and, hospice use. We will characterize caregiver-centered outcomes of patients with ADRD,
including: (1) knowledge, (2) confidence in future care, (3) communication satisfaction, and (4) decisional
certainty in 600 caregivers of patients with ADRD admitted to the hospital. COVID-19 poses a unique dilemma
for older Americans and patients with ADRD and their caregivers, who must balance their desire to live against
the risk of a lonely and potentially traumatic hospital death. Video decision support is a practical, evidence-
based, and innovative approach to assist patients facing such choices. If proven...

## Key facts

- **NIH application ID:** 10399648
- **Project number:** 5R01AG072911-02
- **Recipient organization:** BOSTON MEDICAL CENTER
- **Principal Investigator:** Michael Paasche-Orlow
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $929,442
- **Award type:** 5
- **Project period:** 2021-05-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10399648

## Citation

> US National Institutes of Health, RePORTER application 10399648, Meeting the Challenges of COVID-19 by Expanding the Reach of Palliative Care: Proactive Advance Care Planning with Videos for the Elderly and all Patients with Dementia (5R01AG072911-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10399648. Licensed CC0.

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