Advance Care Planning With Formerly Homeless Older Adults Residing in Permanent Supportive Housing

NCT06239896 | Recruiting

• 1 other identifier: 1R01AG081326-01
• Study Type: interventional
• Target: 650
• Locations: 1 country
• Sites: 6

Brief Summary

The homeless population is aging, with an increasing proportion of individuals over age 50 who experience accelerated aging, high rates of mortality, and a high risk of not having their wishes honored at the end of life. The goal of this randomized control trial (RCT) is to test the effectiveness of adapted evidence-based advance care planning (ACP) interventions for formerly chronically homeless older adults living in permanent supportive housing (PSH).

Conditions

Advance Care Planning

Keywords

Advance Care Planning; Formerly Chronically Homeless; Older Adult; Permanent Supportive Housing; Homelessness; Aging Population; Decision Making; End of Life Care; Medical Decisions

Outcome Measures

Primary Outcomes (1)

• ACP Engagement Survey

  Our primary analyses will compare change in engagement using the 9-item ACP Engagement Survey average 5-point Likert scores from baseline to 3 and 6 months between study arms (groups vs. one-on-one sessions).

  Baseline, 3 months, and 6 months

Secondary Outcomes (1)

• Individual ACP Behaviors

  Baseline, 3 months, and 6 months

Other Outcomes (2)

• Meeting Goals of Care (exploratory)

  Baseline, 3 months, 6 months

• Adverse Outcomes

  Baseline, 3 months, and 6 months

Study Arms (2)

Facilitated Group ACP Session

ACTIVE COMPARATOR

Participants in the group ACP visit arm will attend a one-time 90-minute facilitated group ACP session where they will review the movie version of the PREPARE program (about how to choose a medical decision maker and how to decide what matters most in life), including a new PSH-specific video and PREPARE easy-to-read ADs with the new PSH-specific content and cover letters.

Behavioral: Facilitated Group ACP Session

Facilitated one-on-one ACP visits

ACTIVE COMPARATOR

Participants in the one-on-one ACP visit arm will attend a one-time 90-minute ACP session with a facilitator where they will review the movie version of the PREPARE program (about how to choose a medical decision maker and how to decide what matters most in life), including a new PSH-specific video and PREPARE easy-to-read ADs with the new PSH-specific content and cover letters.

Behavioral: Facilitated one-on-one ACP visits

Interventions

Facilitated Group ACP Session BEHAVIORAL

Group Facilitators will adhere to the standardized scripts and protocols to engage participants in ACP through group sessions. Participants will view the movie version of the PREPARE program (about how to choose a medical decision maker and how to decide what matters most in life), including a new PSH-specific video. Participants are provided with a workbook to follow along with the movies. They are also provide the PREPARE easy-to-read advance directive legal forms that they can fill out when they are ready. These forms include new PSH-specific content and a PSH-specific cover letter.

Facilitated Group ACP Session

Facilitated one-on-one ACP visits BEHAVIORAL

Facilitator adheres to the scripts and protocols to engage participants in advance care planning through one-on-one ACP sessions. Participants will view the movie version of the PREPARE program (about how to choose a medical decision maker and how to decide what matters most in life), including a new PSH-specific video. Participants are provided with a workbook that they can use to follow along with the movies. They are also provide the PREPARE easy-to-read advance directive legal forms that they can fill out when they are ready. These forms include new PSH-specific content and a PSH-specific cover letter.

Facilitated one-on-one ACP visits

Eligibility Criteria

• Age: 50 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Formerly chronically homeless adults living in permanent supportive housing
• English speaking

You may not qualify if:

• Non-English Speaking
• Screen positive for moderate-to-severe cognitive impairment
• Self-report being deaf or blind
• Cannot provide informed consent based on the teach back method

Sponsors & Collaborators

• University of California, San Francisco: lead
• National Institute on Aging (NIA): collaborator

Study Sites (6)

Abode Services

Fremont, California, 94538, United States

RECRUITING

Lifelong Medical Care

Oakland, California, 94612, United States

RECRUITING

Mercy Housing

San Francisco, California, 94102, United States

RECRUITING

Delivering Innovation in Supportive Housing (DISH)

San Francisco, California, 94103, United States

RECRUITING

Episcopal Community Services

San Francisco, California, 94103, United States

RECRUITING

HomeRise

San Francisco, California, 94104, United States

RECRUITING

Related Publications (1)

• Shi Y, Barnes DE, Boscardin J, You JJ, Heyland DK, Volow AM, Howard M, Sudore RL. Brief English and Spanish Survey Detects Change in Response to Advance Care Planning Interventions. J Pain Symptom Manage. 2019 Dec;58(6):1068-1074.e5. doi: 10.1016/j.jpainsymman.2019.09.004. Epub 2019 Sep 18.

  PMID: 31539605 BACKGROUND

Study Officials

• Margot Kushel, MD

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

• Rebecca Sudore, MD

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Layan Kaileh, MSW

CONTACT

415-203-8350; Layan.kaileh@ucsf.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Two-arm, cluster randomized trial to compare the effectiveness of delivering PREPARE-PSH via facilitated groups versus one-on-one visits

Study Record Dates

• First Submitted: January 25, 2024
• First Posted: February 2, 2024
• Study Start: March 6, 2024
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): March 1, 2027
• Last Updated: November 20, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

US (6)