JMIR Publications

ABSTRACT

Background:

Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Mobile applications may help facilitate this process though their use in older adults has been understudied.

Objective:

This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, an online patient-facing ACP platform, among older adults.

Methods:

Older adults (ages 50 and older) who had an active EpicTM MyChart account at an academic healthcare 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 a pre and post-test survey before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and system usability scores (SUS). Exploratory outcomes included ACP knowledge and readiness.

Results:

A total of 161 participants enrolled in the study and created an account on the platform (mean years of age = 63, SD = 9.3), with 80% 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 (e.g., mean increase from 3.2 to 4.2 on 5-pt scale, p < .001) and readiness (e.g., mean increase from 2.6 to 3.2 on readiness to discuss ACP with healthcare provider, p < .001) significantly increased from pre- to post-intervention.

Conclusions:

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 online health tools like Koda may help older individuals learn about and feel more comfortable with ACP, while potentially facilitating greater engagement in care planning. Clinical Trial: This study was supported by a National Science Foundation grant under Award Number 2051460 and the Wake Forest CTSA Grant UL1TR001420. JG was supported by NIA/NIH under Award Number K23AG070234. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.