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This study compared the impact of facilitated versus patient-directed ACP on caregiver psychological symptoms and perceptions of goal-concordant end-of-life (EOL) care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult patients with advanced solid tumors and their caregivers were recruited from 8 oncology clinics in western Pennsylvania. Participants were randomly assigned to complete facilitated ACP with a trained nurse facilitator or patient-directed ACP using written and web-based tools. Caregivers were followed through bereavement and completed surveys assessing depression and anxiety symptoms (Hospital Anxiety and Depression Scale, range 0-21, scores &amp;gt;7 indicative of significant symptoms), post-traumatic stress disorder symptoms (Impacts of Events scale-Revised [IES-R], range 0-88, scores &amp;gt; 24 considered clinically significant), and validated measures of goal-concordant EOL care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 400 enrolled patients, 272 (68%) had an enrolled caregiver. Caregivers were predominantly female (73%), Caucasian (95%), and were spouses\/partners (64%) of the patient with cancer. Among bereaved caregivers (n\u2009=\u200998), those in the facilitated ACP arm reported significantly fewer post-traumatic stress symptoms compared to the patient-directed arm (mean IES-R scores 23.9 vs 31.5, P\u2009=\u2009.01). Both depression and anxiety symptoms remained similar between arms (depression: 5.34 vs 5.87, P\u2009=\u2009.50; anxiety: 6.56 vs 6.72, P\u2009=\u2009.84) and low overall. Caregiver-reported goal-concordant care was higher in the facilitated ACP arm compared to the patient-directed arm (95.8% vs 75.5%, P\u2009=\u2009.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this randomized trial comparing facilitated versus patient-directed ACP, a facilitated approach was associated with lower post-traumatic stress symptoms among bereaved caregivers and higher rates of goal-concordant EOL care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration Number<\/jats:title>\n                    <jats:p>NCT03824158.<\/jats:p>\n                  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