Project Summary This is an initial submission by Hillary Lum, MD, PhD for the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76). Dr. Lum is committed to being a leader in advance care planning (ACP) research, policy initiatives, and healthcare system change to improve care for older adults. She is an internist, geriatrician, and palliative medicine physician in the Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine. Dr. Lum's research focuses on refining an Advance Care Planning Group Visit (ACP-GV) intervention to engage older adults in ACP. This proposed 4-year training plan accelerates Dr. Lum's career development as a patient-oriented researcher and leader in aging through training in: 1) advanced qualitative analysis; 2) implementation science; and 3) pragmatic clinical trials in older adults. She will acquire these skills through intensive interactions with her mentoring team, advanced coursework, guided research, and integrated leadership development, both institutionally and as a Health and Aging Policy Fellow. Dr. Lum's mentorship team and institutional resources are exceptional. As Dr. Lum's primary mentor, Cari Levy, MD, PhD is a nationally recognized researcher and leader in geriatric palliative care and will supervise Dr. Lum's research, career, and leadership development. Dr. Lum is co-mentored by Jean Kutner, MD, MSPH, a skilled leader and expert in palliative care research, including clinical trials in older adults. With funding from the National Palliative Care Research Center and The Colorado Health Foundation, Dr. Lum demonstrated that a novel ACP-GV intervention prototype increased ACP discussions and documentation among older adults in primary care. In order to conduct a real-world clinical trial and ultimately implement this intervention, the next research steps are to standardize the intervention for a general population and adapt the intervention to clinical settings by prioritizing input from patients, clinicians, staff, and health system leaders. Thus, the study objectives are to: 1) develop and refine the ACP-GV intervention to be standardized to the essential intervention components, to be adaptable across clinic settings, and to prioritize ACP outcomes important to key primary care stakeholders, and 2) conduct a pilot randomized controlled trial to test the feasibility, acceptability, and preliminary efficacy of the refined ACP-GV intervention. The culmination of this career development award will assure that Dr. Lum gains the advanced research skills and knowledge to conduct a full-scale effectiveness-implementation trial of an ACP-GV intervention for older adults on patient- centered outcomes. Additionally, she will be specifically positioned to assume expanded and influential national leadership roles to lead policy initiatives to improve ACP with local, regional, and national impact and improve healthcare system delivery of care that is aligned with patient goals.

PROJECT NARRATIVE The Advance Care Planning Group Visit intervention is a new intervention that uses the strengths of group visits to promote advance are planning conversations and documentation. This study will standardize, adapt, and pilot test the Advance Care Planning Group Visit intervention to improve opportunities for older adults to receive medical care that is consistent with their values, goals, and preferences. We will also study the advance care planning-related decision making needs of individuals with cognitive impairment