Encouraging Older Adults and Adults With Serious Illness to Designate a Health Care Proxy

NCT07290478 | Enrolling By Invitation DMC

• 2 other identifiers: UP-23-01203P30AG024968
• Study Type: interventional
• Target: 50,000
• Locations: 1 country
• Sites: 1

Brief Summary

This study is a Stage III randomized trial to encourage patients in advance of a health care appointment to designate a healthcare proxy. Patients will be randomly assigned to receive a mailer containing information about designating a healthcare proxy, or to not receive any mailer. For patients assigned to receive a mailer, the mailer will differ by the presence or absence of a patient pre-commitment prompt, and contain a personalized provider request or a generic health system request. The work will evaluate the randomized trial and identify factors that predict intervention effectiveness.

Conditions

Designating a Healthcare Proxy

Keywords

healthcare proxy; advance care planning; end-of-life care; surrogate decision-maker; durable power of attorney; behavioral economics; pre-commitment

Outcome Measures

Primary Outcomes (1)

• Proportion of patients with EHR-documented healthcare proxy

  Documentation in the electronic health record of a healthcare proxy

  Within 30 days of the patient's first scheduled primary care visit

Secondary Outcomes (5)

• Proportion of patients with legal advance care planning documentation

  Within 30 days of the patient's first scheduled primary care visit

• Proportion of patients that attended scheduled visit

  On the date of the patient's first scheduled primary care visit

• Proportion of patients with EHR-documented healthcare proxy within 90 days

  Within 90 days of the patient's first scheduled primary care visit

• Proportion of patients with legal advance care planning documentation within 90 days

  Within 90 days of the patient's first scheduled primary care visit

• Proportion of patients with primary care visit within 90 days

  Within 90 days of the patient's first scheduled primary care visit

Study Arms (5)

Provider Mailer with a Pre-commitment Prompt

EXPERIMENTAL

Patients will receive a mailer containing a pre-commitment prompt to bring in a form listing their healthcare proxy to their next primary care visit. The mailer will be sent from and signed by their primary care provider.

Behavioral: Mailer; Behavioral: Provider Request; Behavioral: Pre-commitment Prompt

Health System Mailer with a Pre-commitment Prompt

EXPERIMENTAL

Patients will receive a mailer containing a pre-commitment prompt to bring in a form listing their healthcare proxy to their next primary care visit. The mailer will be sent from and signed by the health system

Behavioral: Mailer; Behavioral: Pre-commitment Prompt

Provider Mailer without a Pre-commitment Prompt

EXPERIMENTAL

Patients will receive a mailer, but it will not contain a pre-commitment prompt to bring in a form listing their healthcare proxy to their next primary care visit. The mailer will be sent from and signed by the patient's provider.

Behavioral: Mailer; Behavioral: Provider Request

Health System Mailer without a Pre-commitment Prompt

EXPERIMENTAL

Patients will receive a mailer, but it will not contain a pre-commitment prompt to bring in a form listing their healthcare proxy to their next primary care visit. The mailer will be sent from and signed by the health system.

Behavioral: Mailer

No Mailer Control

NO INTERVENTION

Patients will not receive a mailer.

Interventions

Mailer BEHAVIORAL

Patient mailers will ask the patient to name a healthcare proxy at their next primary care visit.

Health System Mailer with a Pre-commitment Prompt; Health System Mailer without a Pre-commitment Prompt; Provider Mailer with a Pre-commitment Prompt; Provider Mailer without a Pre-commitment Prompt

Provider Request BEHAVIORAL

Patient mailers will be sent from and signed by the patient's provider for their next scheduled primary care visit.

Provider Mailer with a Pre-commitment Prompt; Provider Mailer without a Pre-commitment Prompt

Pre-commitment Prompt BEHAVIORAL

Patient mailers will contain a box that asks the patient to bring a form with their choice for a healthcare proxy to their next primary care visit.

Health System Mailer with a Pre-commitment Prompt; Provider Mailer with a Pre-commitment Prompt

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• No EHR-documented healthcare proxy at enrollment
• Age ≥ 55 years OR age ≥ 18 years and listed in the health system's cancer, CHF, or CKD registries

You may not qualify if:

• None

Sponsors & Collaborators

• Contra Costa Health: collaborator
• University of Southern California: lead
• National Institute on Aging (NIA): collaborator

Study Sites (1)

Contra Costa Regional Medical Center

Martinez, California, 94553, United States

Location

Study Officials

• Mireille Jacobson, PhD

  University of Southern California

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Hospital staff, including clinicians, will not be alerted to the patient's assigned intervention. However, clinicians may learn of the patient's assigned intervention if the patient brings their mailer to the visit.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: 2 x 2 factorial + a no intervention control group

Study Record Dates

• First Submitted: December 12, 2025
• First Posted: December 18, 2025
• Study Start: June 1, 2026
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): September 30, 2027
• Last Updated: June 15, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will share
• Shared Documents: SAP, ANALYTIC CODE
• Time Frame: IPD will be available for one year after the study publication date.
• Access Criteria: IPD access criteria will be governed by a data use agreement signed by both parties.

Locations

US (1)