{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:56:42Z","timestamp":1784177802290,"version":"3.55.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["R01MD014141"],"award-info":[{"award-number":["R01MD014141"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advance care planning (ACP) is the process of discussing one\u2019s goals and wishes for end-of-life care with loved ones or clinicians and then completing an advance directive (AD). Our Community-Based Delivery Model (CBDM) has demonstrated success in engaging these communities, yet the implementation mechanisms behind its effectiveness remain unclear. This study utilized the Consolidated Framework for Implementation Research (CFIR) to evaluate the CBDM in the context of the Project Talk Trial (PTT), a national randomized controlled trial of ACP interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study employed a two-pronged approach. First, CFIR was used to systematically map the CBDM, defining domains and constructs relevant to the intervention\u2019s implementation in diverse community contexts. Second, semi-structured interviews with 24 community hosts who facilitated PTT events provided qualitative insights into the \u201cinner setting,\u201d \u201couter setting,\u201d and \u201cimplementation process\u201d domains. Deductive coding and thematic analysis were used to identify key implementation strategies and challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The CFIR mapping revealed three critical features driving the CBDM\u2019s success: the transfer of resources between outer and inner settings, the central role of community hosts in bridging these domains, and the flexibility to adapt to local contexts. Semi-structured interviews identified five themes, including hosts\u2019 use of relational connections, teaming and engaging strategies, and culturally tailored approaches, which facilitated implementation. Notably, rural hosts exceeded recruitment goals, challenging the notion that rural populations are \u201chard to reach\u201d.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This approach provides actionable insights for improving ACP efforts in communities settings. The integration of CFIR mapping and empirical data highlights the CBDM\u2019s potential as a scalable model for implementing community-engaged health interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0343235","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T17:29:30Z","timestamp":1774632570000},"page":"e0343235","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Using the consolidated framework for implementation research to evaluate a model of community-engaged research in advance care planning"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5681-364X","authenticated-orcid":true,"given":"Erika","family":"VanDyke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Calo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Levi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Tucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0984-1474","authenticated-orcid":true,"given":"Lauren Jodi","family":"Van Scoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Project Talk Trial workgroup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"issue":"5","key":"pone.0343235.ref001","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.jpainsymman.2016.12.331","article-title":"Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel","volume":"53","author":"RL Sudore","year":"2017","journal-title":"J Pain Symptom Manage"},{"issue":"7","key":"pone.0343235.ref002","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-060201","article-title":"What is the evidence for efficacy of advance care planning in improving patient outcomes? A systematic review of randomised controlled trials","volume":"12","author":"C Malhotra","year":"2022","journal-title":"BMJ Open"},{"key":"pone.0343235.ref003","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.c1345","article-title":"The impact of advance care planning on end of life care in elderly patients: randomised controlled trial","volume":"340","author":"KM Detering","year":"2010","journal-title":"BMJ"},{"key":"pone.0343235.ref004","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1093\/milmed\/usac196","article-title":"\u201cAdvancing\u201d Advance Care Planning to Veterans in the Veterans Health Administration","volume":"188","author":"MM Matthieu","year":"2023","journal-title":"Mil Med"},{"issue":"10","key":"pone.0343235.ref005","article-title":"Impact of advance care planning consults on advance directives completion","volume":"27","author":"MA Leak","year":"2021","journal-title":"Am J Manag Care"},{"issue":"2","key":"pone.0343235.ref006","doi-asserted-by":"crossref","DOI":"10.24926\/jrmc.v3i2.2221","article-title":"Advance Care Planning and Advance Directives Completion of Elderly Patients at a Rural Health Clinic on a Regional Medical Campus","volume":"3","author":"S Irvin","year":"2020","journal-title":"Journal of Regional Medical Campuses"},{"key":"pone.0343235.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1200\/JCO.2019.37.31_suppl.1","article-title":"Low advance directive completion rates in hospitalized oncology patients: Room for improvement","volume":"37","author":"M Konda","year":"2019","journal-title":"Journal of Clinical Oncology"},{"issue":"1","key":"pone.0343235.ref008","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1177\/1049909118791126","article-title":"Advance Care Planning in a Geriatric Primary Care Clinic: A Retrospective Chart Review","volume":"36","author":"A Barkley","year":"2019","journal-title":"Am J Hosp Palliat Care"},{"issue":"7","key":"pone.0343235.ref009","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1377\/hlthaff.2017.0175","article-title":"Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care","volume":"36","author":"KN Yadav","year":"2017","journal-title":"Health Aff (Millwood)"},{"issue":"4","key":"pone.0343235.ref010","doi-asserted-by":"crossref","first-page":"34","DOI":"10.3928\/00989134-20151124-02","article-title":"Prevalence of Advance Directives Among Older Adults Admitted to Intensive Care Units and Requiring Mechanical Ventilation","volume":"42","author":"EM Gamertsfelder","year":"2016","journal-title":"J Gerontol Nurs"},{"issue":"1","key":"pone.0343235.ref011","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.amepre.2013.09.008","article-title":"Completion of advance directives among U.S. consumers","volume":"46","author":"JK Rao","year":"2014","journal-title":"American Journal of Preventive Medicine"},{"issue":"2","key":"pone.0343235.ref012","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/MLR.0b013e31827310a1","article-title":"Prior experiences of racial discrimination and racial differences in health care system distrust","volume":"51","author":"K Armstrong","year":"2013","journal-title":"Med Care"},{"issue":"5","key":"pone.0343235.ref013","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1007\/s10903-017-0670-9","article-title":"Facilitators and Barriers for Advance Care Planning Among Ethnic and Racial Minorities in the U.S.: A Systematic Review of the Current Literature","volume":"20","author":"M Hong","year":"2018","journal-title":"J Immigr Minor Health"},{"issue":"5","key":"pone.0343235.ref014","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1071\/AH14152","article-title":"Relinquishing or taking control? 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