• Marie C Haverfield, Jessica Ma, Anne Walling, David B Bekelman, Cati Brown-Johnson, Natalie Lo, Karl A Lorenz, and Karleen F Giannitrapani.
• VA Palo Alto, Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA.
• Palliat Med. 2024 Sep 10: 26921632412773942692163241277394.

BackgroundAdvance care planning initiatives are becoming more widespread, increasing expectations for providers to engage in goals of care conversations. However, less is known about how providers communicate advance care planning within and throughout a health care system.AimTo explore perspectives of communication processes in the rollout of an advance care planning initiative.DesignTheoretically informed secondary analysis of 31 semi-structured interviews.Setting/ParticipantsKey partners in a Veterans Health Administration goals of care initiative.ResultsUsing the constant comparative approach followed by qualitative mapping of themes to the layers of the Socio-Ecological Model, four themes and corresponding Socio-Ecological layers were identified: Goals of Care Communication Training (Policy, Community, and Institutional) requires more resources across sites and better messaging to reduce provider misconceptions and promote an institutional culture invested in advance care planning; Interprofessional Communication (Interpersonal) suggests care team coordination is needed to facilitate continuity in goals of care messaging; Communication in Documentation (Institutional, Interpersonal, and Intrapersonal) highlights the need for capturing the context for goals of care preferences; and Patient/Family Communication (Interpersonal and Intrapersonal) encourages offering materials and informational resources early to facilitate rapport building and readiness to determine goals of care.ConclusionsFindings support the need for initiatives to incorporate an evaluation of how goals of care are discussed beyond the interpersonal exchange between patient and provider and signal opportunities for applying the Socio-Ecological Model to better understand goals of care communication processes, including opportunities to improve initiation and documentation of goals of care.

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