{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T04:41:09Z","timestamp":1760762469774,"version":"build-2065373602"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K76AG064434"],"award-info":[{"award-number":["K76AG064434"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015348","name":"Cambia Health Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015348","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Emergency department (ED) visits offer opportunities for seriously ill patients to formulate future medical care goals, yet ED clinicians lack practical strategies for these conversations. ED GOAL, a behavioral intervention, engages seriously ill yet clinically stable older adults in the ED to address advance care planning (ACP) with their outpatient clinicians. In a randomized trial, goals\u2010of\u2010care documentation was significantly higher in the intervention group compared to controls after three (24.3% vs. 9.9%, <jats:italic>p<\/jats:italic>\u2009=\u20090.03) and 6\u2009months (31.4% vs. 12.7%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). This study is a sub\u2010analysis to learn about intervention arm participants' perceived benefits and obstacles of the intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted semi\u2010structured interviews between October 2022 and August 2024 (<jats:italic>N<\/jats:italic>\u2009=\u200952) with intervention\u2010arm patients aged 50+ years at three hospitals in Boston, Massachusetts. Using rapid qualitative analyses, we identified themes in intervention\u2010arm participants' comments to open\u2010ended questions about the intervention's benefits and obstacles to continue ACP outside the ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 70 intervention\u2010arm participants, 52 completed interviews, of which two were surrogates. ED GOAL motivated most patients to initiate ACP with outpatient clinicians and loved ones and improved the quality of conversations by clarifying patients' wishes and improving patient\u2010clinician relations. Barriers to continuing ACP were the lack of clinician availability and patient\/surrogate readiness. Those with clear care goals found the intervention less useful yet harmless.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The intervention provided participants with insights into actionable ACP steps. To address the lack of clinician availability, these conversations may be completed by non\u2010physician clinicians or through non\u2010personnel resources. Better tailored ACP interventions may improve patients' readiness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link> identifier: NCT05209880<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.70109","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T14:52:22Z","timestamp":1753800742000},"page":"1076-1083","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring Patients' Perceptions of an Advance Care Planning Intervention in the Emergency Department: A Qualitative Study"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6998-3724","authenticated-orcid":false,"given":"Youkie","family":"Shiozawa","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saaya","family":"Morton","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nanako","family":"Shirai","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Oelschlager","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucy","family":"Kiernat","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita N.","family":"Chary","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna C.","family":"Revette","sequence":"additional","affiliation":[{"name":"Survey and Data Management Core, Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4106-7055","authenticated-orcid":false,"given":"Adrian","family":"Haimovich","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Smit","family":"Desai","sequence":"additional","affiliation":[{"name":"Northeastern University  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai\u2010Wei","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Computer Science University of California  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5602-3717","authenticated-orcid":false,"given":"Shan W.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Emergency Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maura","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Emergency Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mara A.","family":"Schonberg","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Emergency Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2723-4259","authenticated-orcid":false,"given":"Kei","family":"Ouchi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Psychosocial Oncology and Palliative Care Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.0922"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2014.0368"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnad020"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.4672"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1411746"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.3102"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.14.1665"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.0292"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.0077"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-022-06797-6"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2011.06.014"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-012-2116-3"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/1099-1166(200011)15:11<1021::AID-GPS234>3.0.CO;2-6"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadm.2015.03.003"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-019-0853-y"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/07334648231206742"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2023.06.027"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2024.10.034"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.3833"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20190179"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2018.0487"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1200\/EDBK_431352"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2022.09.003"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/wvn.12530"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c1345"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-023-01229-x"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hjdsi.2017.01.001"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/0825859718757131"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2015.008896"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049909117745789"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/oncolo\/oyae216"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2010.0299"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27423"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-022-00556-2"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/02692163231194202"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049909120969202"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2017.09.024"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18262"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0204890"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.70109","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T04:15:50Z","timestamp":1760760950000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.70109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":40,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/acem.70109"],"URL":"https:\/\/doi.org\/10.1111\/acem.70109","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"type":"print","value":"1069-6563"},{"type":"electronic","value":"1553-2712"}],"subject":[],"published":{"date-parts":[[2025,7,29]]},"assertion":[{"value":"2025-04-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}