# I CAN DO Surgical ACP (Improving Completion, Accuracy, and Dissemination Of Surgical Advanced Care Planning) Trial

> **NIH NIH UH3** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2024 · $1,371,949

## Abstract

Project Summary
Nearly 20 million older adults undergo major elective surgical procedures, yet very few receive advance care
planning (ACP). This is a critical missed opportunity to ensure optimal and patient-aligned medical decisions and
communications. Despite ACP being incorporated into national quality metrics and society guidelines for surgical
care for older adults, there are few examples of effective integration into the pre-surgical phase. Efforts to date
have mostly focused on improving surgeons’ use of ACP but barriers remain significant, including varying levels
of familiarity and comfort to conduct ACP conversations, lack of dedicated time during the pre-surgical care
episode for these often-delicate conversations, and lack of appropriate patient-facing ACP tools to help patients
and caregivers make complex decisions about their surgical treatment. Our team has designed and tested a
theory-based, interactive ACP patient-facing technology solution (PREPARE) based on the new ACP paradigm
of preparing people for communication and medical decision-making. Despite consistent evidence that
PREPARE increases ACP engagement and patient and clinician empowerment to discuss ACP, a gap remains
in extending PREPARE’s use to pre-surgical populations. We hypothesize that by including PREPARE into the
electronic health record (HER)-centric pre-surgery workflow for older adults and including automated reminders,
we can empower patients and surgical teams to engage in ACP discussions. Given the limited time and
resources in the surgical setting to conduct ACP, we will be testing 3 delivery strategies in increasing resource
intensity (PREPARE alone, PREPARE with text/phone reminders, or the additional of a healthcare navigator).
To ensure generalizability, we will conduct our work in 3 healthcare systems (HCS): Univ. of CA, San Francisco
(UCSF), Univ. of CA, Irvine (UCI) and M Health Fairview (UMN, a collaboration among the Univ. of MN Medical
School, Univ of MN Physicians, and Fairview Health Services). We will first establish trial infrastructure (UG3) to
conduct (UH3) an NIH Stage Model III (efficacy-effectiveness) three arm RCT in 3 HCS. Patients aged 65 or
older, or with serious illness, who are referred for major elective surgery will be randomized to Arms: (1) Letter
about ACP, PREPARE advanced directive (AD), PREPARE website; (2) Letter, AD, PREPARE plus reminder
text/phone messages; (3) Letter, AD, PREPARE plus reminders plus a healthcare navigator on ACP
documentation (discussions and care plans, primary outcome) and patient-reported ACP engagement. Using
mixed methods, we will assess patients’ and surgical care teams' experience with surgery ACP. ACP note
content will be evaluated using natural language processing (NLP) and data mining to begin to identify assess
thematic completeness of ACP notes. This work is innovative because we are coalescing existing collaborations
between HCS into a transdisciplinary group of surgeons, geriatricians, ...

## Key facts

- **NIH application ID:** 11124483
- **Project number:** 4UH3AG081663-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Genevieve B Melton-Meaux
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $1,371,949
- **Award type:** 4N
- **Project period:** 2023-08-01 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11124483

## Citation

> US National Institutes of Health, RePORTER application 11124483, I CAN DO Surgical ACP (Improving Completion, Accuracy, and Dissemination Of Surgical Advanced Care Planning) Trial (4UH3AG081663-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/11124483. Licensed CC0.

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