To the Editor We highly commend Mitchell and colleagues1 for conducting a large-scale pragmatic randomized clinical trial of an advance care planning (ACP) video intervention in 360 nursing homes (Pragmatic Trial of Video Education in Nursing Homes, or PROVEN). The intervention did not reduce hospital transfers over 12 months nor burdensome treatments, nor did it increase hospice enrollment among long-stay residents. Mitchell et al1 and Courtright and Halpern2 suggest several explanations for their trial results. We would like to highlight an important additional challenge that may have contributed to the findings.
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Gilissen J, Van den Block L, Pivodic L. Complexities and Outcomes of Advance Care Planning. JAMA Intern Med. 2021;181(1):142–143. doi:10.1001/jamainternmed.2020.5539
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