Implementation of a Goals-of-Care Communication Priming Intervention Tailored to Outpatient Stroke Survivors: A Pilot Study

Abstract

Background: Serious illness communication priming guides like the Jumpstart Guide can increase goals-of-care conversations (GOCC), but have not been evaluated in the stroke population. Objectives: To conduct a randomized pilot study evaluating feasibility and acceptability of the Jumpstart Guide adapted for outpatient stroke survivors, their surrogates, and clinicians. Methods: We recruited stroke survivors ≥60 years of age (or their surrogates if patients had communication barriers) at a single academically-affiliated stroke clinic. Patients/surrogates were randomized to intervention (patient/surrogate and clinician received pre-visit Jumpstart Guide) or control arms. We assessed feasibility of participant enrollment, survey completion and extraction of GOCC documentation. We assessed acceptability using patient/surrogate and clinician surveys. Results: We enrolled 15/24 (63%) of eligible patients or surrogates, 8 of which were randomized to the intervention vs 7 to the control arm. Six clinicians were enrolled for the 8 intervention encounters. Patient characteristics in both groups were similar with mean age 74.7 years, 10/15 male, 12/15 white, and 10/15 with acute ischemic stroke. Most patients/surrogates (7/8 intervention vs 7/7 control) and all intervention clinicians completed post-visit surveys. Most intervention participants reported successful pre-visit receipt of the Jumpstart Guide (6/7 patient/surrogates; 6/8 clinicians). Of these, all intervention patients/surrogates and 5/6 clinicians stated they would “definitely” or “probably” recommend it to others. Two intervention vs no control patients had newly documented GOCC post-visit. Conclusions: Implementation of a stroke-specific Jumpstart guide in an outpatient stroke clinic is feasible and acceptable. A large randomized controlled trial is needed to evaluate its efficacy in improving GOCC.