Plan ahead

Clinical Brief – August 23rd

The Brief

A group at UCSF developed a website to help people with advance care planning called PREPARE.

Their trial with veterans showed that significantly more people made advance care plans using PREPARE together with their simple advance directive forms than with the forms alone.

What’s advance care planning?

Advanced care planning is where patients talk about and document their wishes towards the end of life. Kind of important, considering an ill-advised decision can be quite devastating.

But this process is medicine with a hint of law; i.e., not people friendly. A sticking point is a need for patients to write down their wishes in a legal form called an advance directive. So, it’s probably not surprising to see trial authors say that “most older adults, even those with serious illness, have not engaged in advance care planning”; citing the confusing advance directive forms as a notable barrier.


PREPARE was founded in 2008 by a geriatrician/palliative care physician at the UCSF, Dr Rebecca Sudore, MD, FAAHPM.

It started with an easy-to-use advance directive form for the state of California and grew to also include a website to help patients engage in their advance care planning.

Alright, go back to the trial.

About 400 veterans at the San Francisco VA was randomly selected to receive the simple advance directive form or both the form plus access to the PREPARE website.

Nine months into the trial, over 1 in 3 vets who used the PREPARE site with the simplified forms had documented advance care plans, compared to 1 in 4 vets who only used the simplified forms.

Satisfaction scores were high for both methods, and both were thought to be easy to use and helpful.

No side effects were reported and no differences in depression or anxiety between groups were seen after 6 months into the trial.

Bottom line

When we think about it, the birth of a new life takes at least 9 months to plan. How long should we spend planning for when we go and meet our maker?

All this is to say that advance care planning is vital for ensuring that we get the care we are hoping for towards the end of life.

Any tool that can help make this process easier is worth looking into, and PREPARE seems like a fantastic start. Of course, like every tool, it won’t work for everyone or in every situation. But take a look and see if it can help you or a loved one.

“Easy-to-use, patient-facing advance care planning tools, without clinician- and system-level interventions, can increase advance care planning documentation by 25% to 35%.”

– Sudore RL, et al.


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