Evaluating a tailored communication tool to increase advance care planning among Alaska Native and American Indian people in primary care: A type 1 hybrid effectiveness-implementation cluster randomized trial protocol

The older Alaska Native/American Indian (AN/AI) population is increasing faster than their U.S. peers overall, yet AN/AI peoples are less likely to receive palliative care, including advance care planning (ACP). ACP aims to align care with patient priorities and can improve health-related quality of life for people with serious illness and their families, including a reduction in psychological distress, physical symptoms, unwanted treatments, and cost. ACP ideally includes documentation of advance directives to guide medical decisions when patients cannot speak for themselves. AN/AI peoples are more likely to engage in palliative care services, including ACP, when they are culturally tailored, yet few such evidence-based interventions exist. In a previous study, we used community engaged methods to tailor and pilot the Jumpstart ACP communication intervention with 58 AN/AI adult patients with serious illness in an Alaska Native health system. That study found the tailored Jumpstart to be highly acceptable and feasible but was not statistically powered to evaluate intervention efficacy. This paper describes the protocol for a fully-powered, cluster randomized, type 1 hybrid effectiveness-implementation trial of the tailored Jumpstart among 400 AN/AI adults in Alaska. This study will provide critical evidence for improving serious illness care outcomes and health equity in AN/AI communities.