# Engaging underserved communities in end-of-life conversations: a cluster, randomized controlled trial

> **NIH NIH R01** · PENNSYLVANIA STATE UNIV HERSHEY MED CTR · 2022 · $379,878

## Abstract

ABSTRACT
Advance care planning (ACP) is a process that involves of having conversations with loved ones/clinicians
about one’s goals or wishes for end-of-life care, and then documenting them in advance directives. ACP helps
to reduce the likelihood that patients received overly aggressive and unwanted treatments at the end of life. It
is especially critical to encourage ACP for those who are at high risk of losing capacity to make their own
medical decisions (such as those with mild cognitive impairment (MCI) and/or are at risk for Alzheimer’s
Disease and related dementias; r-MCI/ADRD) so that they may still participate in decision-making related to
their medical care before disease progression. Further, those living in underserved communities (e.g., those
living in African American, Hispanic, or rural areas) disproportionately experience low quality end-of-life care as
a result of a lack of ACP and other health disparities. The goal of the parent trial is to learn whether a
conversation game (Hello) compared to a traditional ACP approach (Conversation Project Starter kit), or a
control arm is most effective in motivating participants to complete ACP. However, the trial excludes individuals
with r-MCI/ADRD due to concerns related to interventional appropriateness for those with cognitive
impairment. This is unfortunate because these individuals are among those most in need of urgent ACP before
their disease progresses to a point where patients are unable to make decisions for themselves. Due to its
structure and unique ability to foster psychological safety, Hello may be uniquely suited for individuals with r-
MCI/ADRD because of its elegant simplicity and ability to provide a safe and non-threatening forum for patients
and their loved ones to talk together about their goals and values related to medical care. Thus, the goal of this
supplement is to adapt the Hello intervention so that it may be tailored to suit the needs of individuals with r-
MCI/ADRD so that future trials may include these groups. To do so, we will host game events in diverse
communities and then using focus groups, questionnaires and 3-month follow-up interviews to assess how the
participants perceived the intervention, if and how it should be modified for those with r-MCI/ADRD, and to
learn if the game successfully motivates participants to complete ACP behaviors. Upon completion of the
study, we will be prepared for future trials that can evaluate this low-cost and easily disseminated intervention
to serve individuals with r-MCI/ADRD.

## Key facts

- **NIH application ID:** 10498316
- **Project number:** 3R01MD014141-02S1
- **Recipient organization:** PENNSYLVANIA STATE UNIV HERSHEY MED CTR
- **Principal Investigator:** Lauren Jodi Van Scoy
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $379,878
- **Award type:** 3
- **Project period:** 2020-09-17 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10498316

## Citation

> US National Institutes of Health, RePORTER application 10498316, Engaging underserved communities in end-of-life conversations: a cluster, randomized controlled trial (3R01MD014141-02S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10498316. Licensed CC0.

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