Our Research

The Stanford Letter Project was created after extensive research and discussions with multi-ethnic patients and families as well as health personnel from various domains and sub-specialties.

 

American Medical Association Practice Improvement Module using the Stanford Letter Project:

You can view a module on the Letter project by the AMA here:  

https://www.stepsforward.org/modules/end-of-life-planning

 

Relevant published research papers:

Do Unto Others: Doctors' Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives

No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients

Patient-Reported Barriers to High-Quality, End-of-Life Care: A Multiethnic, Multilingual, Mixed-Methods Study.

Unmet quality indicators for metastatic cancer patients admitted to intensive care unit in the last two weeks of life.

Ongoing research using the Stanford Letter Project:

Large observational study using the Stanford Letter Project

We are building a national Letter Library of letters written by people who have utilized the Stanford Letter project template and shared it with us for research. Our goal is to build a large online searchable library of letters that any patient can use to complete their advance care planning.

Feasibility trial using the Stanford Letter Project

We have completed a large feasibility trial and the manuscript is currently under review by a prominent peer reviewed medical journal.

Bone Marrow Transplant (BMT) population

  • Patient-Proxy Alignment Study: We are conducting a study to better understand the differences (if any) between patients receiving Bone Marrow Transplant and their proxy decision makers as determined by the  Stanford Letter Project directive
  • BMT patient randomized clinical trial: We have recently received funding from the Palliative Care Research Cooperative to complete a randomized clinical trial comparing the Stanford Letter project directive to traditional directive in the bone marrow transplant population.their advance care planning.

Quality Improvement Project at Stanford Hospital using the Stanford Letter Project

We have conducted a quality improvement project comparing the Stanford Letter Project Directive to traditional advance directive. Key findings were as follows:

  • The Stanford  Project Letter Directive improved general understanding of patients’ goals and values compared to the traditional advance directives.
  • The Stanford  Project Letter Directive improved provider understanding of where patients would like to spend their last days (home vs hospital).
  • The Stanford  Project Letter Directive may increase provider understanding of their patients’ values and Goals of Care.
  • Doctors overwhelmingly felt the Letter was helpful and would be useful in guiding Goals of Care discussions with their patients.