Using a video on advance care planning for diverse adults in safety-net, primary care settings is feasible, a recent study concluded.1

“While we know advance care planning can help patients receive medical care aligned with their wishes, there are numerous barriers to discussing and documenting this information,” says Rebecca Sudore, MD, one of the study’s authors. Obstacles to good advance care planning include the following:

• limited time during provider visits;

• providers’ discomfort with the subject matter;

• patients’ limited health literacy.

“The motivation for this study was to improve accessibility to advance care planning for disenfranchised patients,” explains Sudore, a professor of medicine at University of California, San Francisco.

Researchers conducted two 90-minute group visits one week apart at Northern California safety-net primary care clinics. Of the 22 participants, 73% were people of racial or ethnic minorities. Forty-six percent showed limited health literacy. “We were surprised by the effectiveness of this delivery model,” says Sudore.

Video Increases Knowledge

Participants watched a video covering surrogates, values for medical care, and discussing wishes. Two clinician facilitators encouraged discussion among the participants, but all educational content came from the video.

At the end of the group visit, facilitators asked participants to discuss their wishes with family and friends and to complete an advance directive. No assistance with advance care planning documentation was provided.

“We were surprised that the group participants were able to obtain all of the key information directly, and how little facilitation was required,” says Sudore.

Knowledge about surrogate designation improved. “Advance care planning discussions with others and surrogate designation increased significantly,” says Sudore.

Historically, advance care planning rates among disenfranchised, safety-net patient populations have been low. The study’s findings suggest that simply watching a video can help with this.

“This group visit model could address some of the barriers to advance care planning in routine office visits and in resource-poor, safety-net settings,” concludes Sudore.


1. Zapata C, Lum HD, Wistar, et al. Feasibility of a video-based advance care planning website to facilitate group visits among diverse adults from a safety-net health system. J Pall Med 2018; 21(6):853-856.


• Rebecca Sudore, MD, Professor of Medicine, University of California, San Francisco. Phone: (415) 221-4810 ext. 23475. Email: