PROJECT SUMMARY/ABSTRACT
Proactive goals of care conversations (GoCCs) are discussions between patients, providers, and family
members prior to patients’ decline in health to ensure they receive end of life care that is concordant with their
preferences and values. Proactive GoCCs lead to improved quality of life near death, reduce low-value medical
expenditure near the end of life, and reduce distress for family members. Despite the benefits of proactive
GoCCs, racial/ethnic minorities are less likely to have had proactive GoCCs with their providers and their
family members compared to white patients, putting them at significant risk of receiving end of life care that is
discordant with their preferences. Recently, the Covid-19 pandemic created an urgency to conduct proactive
GoCCs; highlighted the disparate GoCC rates with racial/ethnic minorities; and catalyzed alternative methods,
including telehealth, of reaching racial/ethnic minorities for proactive GoCCs. Telehealth, defined as real-time
communication between providers and patients using telephone or video conferencing, offers us an opportunity
to reach racial/ethnic minorities for proactive GoCCs. Multiple studies have demonstrated that Black/African
American and Hispanic patients prefer a telehealth approach for certain portions of their care, given that they
face greater healthcare access barriers. Yet little is known about the implementation of telehealth GoCCs, or
the impact of telehealth GoCCs particularly among racial and ethnic minorities. Leveraging the vast Veterans
Health Administration’s (VA) database of all Veterans nationwide, this work proposes the first critical steps in
understanding (1) the reach of telehealth for GoCCs with racial/ethnic minorities and (2) the adoption of
telehealth for GoCCs by all VA medical facilities across the nation. This pilot study will inform us as to whether
or not telehealth is a viable option for proactive GoCCs with racial/ethnic minorities with the aim of addressing
the disparate rate of GoCCs for this underserved population. This work will also inform the next step of my
career development research track which is assessing the effectiveness of telehealth for GoCCs by evaluating
the concordance between the GoCC preferences elicited via telehealth and actual end of life care received.
Together the hands-on mentored research experience and the carefully designed didactics and sponsorship
this F32 award provides will advance my career goal of becoming a leading independent physician scientist
focused on mitigating disparities in end of life care for racial and ethnic minorities.
