• Jessica L Colburn, Daniel L Scerpella, Margo Chapin, Kathryn A Walker, Sydney M Dy, Martha Abshire Saylor, Neha Sharma, Sri Rebala, Ryan E Anderson, Maura McGuire, Naaz Hussain, Christine Rawlinson, Valerie Cotter, Kimberly Cockey, David L Roth, Karyn Lee Carlson Nicholson, Erin Rand Giovannetti, Marcella B Sancho, Diane Echavarria, Cynthia M Boyd, Jennifer L Wolff, and Kelly M Smith.
• Division of Geriatric Medicine & Gerontology (JLC, CMB), Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jcolbur1@jhmi.edu.
• J Pain Symptom Manage. 2023 Aug 1; 66 (2): e255e264e255-e264.

BackgroundFew advance care planning (ACP) interventions have been scaled in primary care.ProblemBest practices for delivering ACP at scale in primary care do not exist and prior efforts have excluded older adults with Alzheimer's Disease and Related Dementias (ADRD).InterventionSHARING Choices (NCT#04819191) is a multicomponent cluster-randomized pragmatic trial conducted at 55 primary care practices from two care delivery systems in the Mid-Atlantic region of the U.S. We describe the process of implementing SHARING Choices within 19 practices randomized to the intervention, summarize fidelity to planned implementation, and discuss lessons learned.OutcomesEmbedding SHARING Choices involved engagement with organizational and clinic-level partners. Of 23,220 candidate patients, 17,931 outreach attempts by phone (77.9%) and the patient portal (22.1%) were made by ACP facilitators and 1215 conversations occurred. Most conversations (94.8%) were less than 45 minutes duration. Just 13.1% of ACP conversations included family. Patients with ADRD comprised a small proportion of patients who engaged in ACP. Implementation adaptations included transitioning to remote modalities, aligning ACP outreach with the Medicare Annual Wellness Visit, accommodating primary care practice flexibility.Lessons LearnedStudy findings reinforce the value of adaptable study design; co-designing workflow adaptations with practice staff; adapting implementation processes to fit the unique needs of two health systems; and modifying efforts to meet health system goals and priorities.Copyright © 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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