A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study

• Published in: JMIR aging Vol. 7; p. e54128
• Main Authors: Roberts, R Lynae, Cherry, Katelin D, Mohan, Desh P, Statler, Tiffany, Kirkendall, Eric, Moses, Adam, McCraw, Jennifer, Brown III, Andrew E, Fofanova, Tatiana Y, Gabbard, Jennifer
• Format: Journal Article
• Language: English
• Published: Canada JMIR Publications 06.05.2024; JMIR Aging
• Subjects: Advance Care Planning; Advance directives; Aged; Decision making; Electronic health records; Feasibility Studies; Female; Health care policy; Health Care Quality and Health Services Research; Health Services Research and Health Care Utilization in Older Patients; Humans; Illnesses; Internet; Internet-Based Intervention; Intervention; Involvement of Elderly Populations in Health and Health Services Reserch; Male; Middle Aged; Mobile Devices and Apps for Seniors and Healthy Aging; New Services for the Elderly; North Carolina; Older people; Original Paper; Participatory Medicine & E-Patients; Patients; Personal Health Records, Patient-Accessible Electronic Health Records, Patient Portals; Pilot Projects; Quality of life; Surveys and Questionnaires; Usability; Usability and Technology Use Studies with Elder Subjects; Verbal communication; North Carolina; United States > US; ageing; older person; website; elderly; elder; gerontology; ACP; platform; older adult; geriatrics; adoption; digital health; usability; acceptance; older adults; older people; websites; aging; geriatric; system usability; advance care planning; digital health tools
• DOI: 10.2196/54128
• ISSN: 2561-7605

Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning.