RPD217 - Advance Care Planning Group Visits: Implementation for English and Spanish-speaking Older Adults

Key Message : In the context of a multi-site clinical trial, clinician-led advance care planning (ACP) group visits are achievable for English and Spanish-speaking older adults in primary care settings, including those with potential cognitive impairment. This reimbursable, patient-centered model may support engaging older adults in ACP discussions.

Abstract:

Background:
Advance care planning (ACP) discussions for patients with serious illness, including cognitive impairment, ideally occur in primary care. However, barriers prevent implementation, especially in Spanish-speaking populations. Group-based ACP discussions offer a supportive approach with peer support and shared learning experiences.


Objectives:
To implement primary care-based ACP group visits, including for Spanish-speaking older adults.


Methods:
In a multi-clinic trial, primary care teams were trained to foster interactive ACP group discussions in culturally and linguistically aligned ways. Clinic teams implemented ACP group visits for adults age 70 years and older.(1) Visits were co-facilitated by a clinician and another healthcare professional. Patients attended two sessions: Session A included building rapport, introducing ACP concepts, and goal setting; Session B included follow-up questions, addressing concerns, and sharing reflections. Research staff completed fidelity check-lists of session dynamics, participant engagement, and facilitator approaches, using video recordings. Fidelity summaries were created across visits at each clinic.


Results:
Of 3774 eligible patients, 3592 refused and 518 (12.6%) enrolled, including 35% with a below normal cognitive screen. Forty-six ACP group visit cohorts (7 Spanish-language) were conducted in 8 clinics. Groups averaged 6 participants (range 1-12). Sessions averaged 91 and 86 minutes (Session A and B). Participants displayed strong peer connections and support despite emotionally challenging conversations. Fidelity to the intervention protocol was high in both languages. Spanish-speaking facilitators added role-play techniques to improve comprehension of ACP concepts. Spirituality and faith-based discussions emerged more frequently in Spanish-speaking groups, particularly when discussing decision-making and ACP documentation.

Conclusion:
ACP group visits were implemented across multiple clinics in English or Spanish. Visits supported for older adults, including several with potential cognitive impairment. There was greater integration of spiritual perspectives in Spanish language groups. ACP group visits provide education combined with peer support, suggesting a reimbursable approach to ACP discussions in primary care.

References: 1. Farro SA, Juarez-Colunga E, Patel C, et al. Engaging English- and Spanish-speaking older adults with and without possible cognitive impairment in advance care planning group visits: protocol for the ENgaging in Advance Care Planning Talks (ENACT) randomized controlled trial. Trials. 2025;26(1):353. doi:10.1186/s13063-025-08964-x