Evaluating a tailored communication tool to increase advance care planning among Alaska Native and American Indian people in primary care: A type 1 hybrid effectiveness-implementation cluster randomized trial protocol

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Abstract
The older Alaska Native/American Indian (AN/AI) population is increasing faster than their U.S. peers overall. However, AN/AI peoples are less likely to receive palliative care, including advance care planning (ACP). ACP leads to better outcomes for patients, their families, and health systems, including decreased depression, anxiety, and grief, fewer non-beneficial end-of-life treatments, and reduced cost. ACP is typically documented in advance directives that specify patient preferences for life-sustaining treatments and who can make medical decisions on their behalf. AN/AI peoples are as likely as non-AN/AI peoples to utilize palliative care when it is culturally tailored. Therefore, there is an urgent need for strategies to provide tailored palliative and end-of-life care interventions for AN/AI people. Our team used community engagement methods to tailor an ACP communication intervention and pilot the tailored intervention—Jumpstart—with seriously ill adult AN/AI peoples within a Tribal health system. Most (95%) of patients in the pilot stated that Jumpstart helped them to have ACP conversations with their primary care providers. The current study uses a type 1 hybrid effectiveness-implementation randomized controlled trial to examine the effectiveness of a tailored ACP intervention and evaluate implementation variables. This study will provide critical evidence for improving care for seriously ill AN/AI peoples and their families.