Opinion EDITORIAL Vinay Guduguntla, MD; Tracy Wang, MD, MHS, MSc; Deborah Grady, MD, MPH Advance care planning (ACP) is a stepwise process that ad- ference toward patient autonomy and the spirit of informed dresses patient preferences for advance directives, durable consent. However, there are certain circumstances for which power of attorney, and end-of-life care. These discussions of- this design can be ethical and beneficial. The randomization-first approach reduces selection ten lead to higher-quality, goal-concordant care for bias, as it avoids the issue of clinicians only referring Related article patients. Yet, ACP rarely oc- patients to the trial who they believe will benefit from the curs in the ambulatory care intervention. Because the control group is unaware of the setting. Moreover, current approaches to ACP often fail to en- intervention, Zelen’s design can minimize any changes in gage patients and their families or are not well integrated into behavior that occur when participants know they are being clinician workflow. observed as part of a study (ie, Hawthorne effect). Moreover, In this issue of JAMA Internal Medicine, Gabbard et al as- because some of the intervention patients, and all of the sessed the efficacy of a nurse navigator and electronic health
JAMA Internal Medicine – American Medical Association
Published: Mar 11, 2021
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