{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:23:37Z","timestamp":1792506217389,"version":"4.5.0"},"reference-count":44,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:00:00Z","timestamp":1777680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:00:00Z","timestamp":1777680000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG058671"],"award-info":[{"award-number":["R01AG058671"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Supporting involvement and engaging care partners in advance care planning (ACP) conversations is a best practice principle that is especially important in the context of cognitive impairment. This study applied an existing decision\u2010making framework (1) autonomous, (2) shared, (3) delegated, and (4) surrogate to describe types of patient and care partner involvement in ACP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Deductive content analysis of transcripts from ACP conversations involving 88 older adults with mild (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915), moderate (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913), and severe (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200960) cognitive impairment and care partners.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patient involvement in ACP decision\u2010making was highly related to patient level of cognitive impairment. Many older adults with mild cognitive impairment (60%) were able to state clear preferences for end\u2010of\u2010life treatments. With higher severity of cognitive impairment, patients were more reliant on care partners and required a greater level of support. Among older adults with severe impairment, surrogate decision\u2010making with known preferences was most common (48.3%). Delegated decision\u2010making was rare (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092) and driven by patient preference rather than cognitive limitation. Care partners shared a common role in supporting patient involvement in each decision\u2010making type, but the required level of support increased with the severity of cognitive impairment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings underscore the vital and evolving role of care partners in ACP for older adults with cognitive impairment. Supporting and intentionally involving care partners early\u2014while respecting patients' preferences for autonomy\u2014may help reduce decisional burden and promote person\u2010centered ACP as cognitive impairment progresses. These insights can inform clinical guidelines on dyad\u2010centered approaches to ACP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70476","type":"journal-article","created":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T12:15:08Z","timestamp":1777724108000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Involvement of Patients With Cognitive Impairment and Care Partners in Advance Care Planning Decision\u2010Making: A Qualitative Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4203-4749","authenticated-orcid":false,"given":"Peiyuan","family":"Zhang","sequence":"first","affiliation":[{"name":"University of Alabama, School of Social Work  Tuscaloosa Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valecia","family":"Hanna","sequence":"additional","affiliation":[{"name":"Johns Hopkins, Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glory Huynh","family":"Thai","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, School of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chase Mulholland","family":"Green","sequence":"additional","affiliation":[{"name":"Johns Hopkins, Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Cagle","sequence":"additional","affiliation":[{"name":"University of Maryland, School of Social Work  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Wolff","sequence":"additional","affiliation":[{"name":"Johns Hopkins, Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha 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