Promoting Goals-of-Care Discussions for Patients With Memory Problems and Their Caregivers

The goal of this clinical trial is to improve communication among clinicians, patients with memory problems, and their family members. We are testing a way to help clinicians have better conversations to address patients' goals for their healthcare. To do this, we created a simple, short guide called the "Jumpstart Guide." The goal of this research study is to show that using this kind of guide is possible and can be helpful for patients and their families. Patients' clinicians may receive a Jumpstart Guide before the patient's clinic visit. Researchers will compare patients whose clinician received a Jumpstart Guide to patients whose clinician did not receive a guide to see if more patients in the Jumpstart Guide group had conversations about the patient's goals for their healthcare. Patients and their family members will also be asked to complete surveys after the visit with their clinician.

PATIENTS Inclusion Criteria: * Be cared for as an outpatient at a UW Medicine clinic * 55 years of age or older * Have an ICD-10 code for ADRD documented in the EHR within the prior two years If patients are cared for in a primary care setting within UW Medicine or by a geriatrician or neurologist, only a diagnosis of ADRD is required for eligibility. If patients have ADRD and are not followed by a primary care clinician at UW Medicine but are followed by a subspecialist, eligible patients must also have an ICD-10 code for one or more of seven chronic conditions used by the Dartmouth Atlas, relevant for the specialist they see, to ensure that goals-of care discussions are applicable for these specialists in the care of the enrolled patient. These conditions by specialist are: malignant cancer/leukemia (oncologist), chronic pulmonary disease (pulmonologist), coronary artery disease or heart failure (cardiologist), chronic liver disease (hepatologist), chronic renal disease (nephrologist), and diabetes with end-organ damage (endocrinologist). Exclusion Criteria: * restricted status, legal or risk management concerns * without capacity to complete informed consent procedures and without a legal surrogate to enroll them (for the survey component or qualitative interviews) * non-English speaking (for the survey component or qualitative interviews) * patients of a clinician who has opted-out of the study will not be eligible for the study under the care of that clinician but may be eligible if they also receive care from another clinician in a participating clinic FAMILY MEMBERS Inclusion Criteria: * Identified (via the patient or the EHR) as the person most involved in care for an eligible patient in the trial * 18 years of age or older * English language proficiency Exclusion Criteria: * legal or risk management concerns * psychological illness or morbidity preventing completion of study materials * physical or mental limitations preventing completion of study materials * non-English speaking Not all patients will have an eligible family member to enroll. CLINICIANS Inclusion Criteria: * Physician or advance practice provider caring for older adults within UW Medicine clinics * 18 years of age or older * English language proficiency * (Interviews) Identified as clinician of record for an enrolled patient in the trial and received a Jumpstart guide Exclusion Criteria: * legal or risk management concerns