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OBJECTIVES To evaluate physicians' views on advance care planning, goals of care, and end‐of‐life conversations. DESIGN Random sample telephone survey. SETTING United States. PARTICIPANTS Physicians (primary care specialists; pulmonology, cardiology, oncology subspecialists) actively practicing medicine and regularly seeing patients aged 65 and older (N=736; 81% male, 75% white, 66% aged ≥50. MEASUREMENTS A 37‐item telephone survey constructed by a professional polling group with national expert oversight measured attitudes and perceptions of barriers and facilitators to advance care planning. Summative data are presented here. RESULTS Ninety‐nine percent of participants agreed that it is important to have end‐of‐life conversations, yet only 29% reported that they have formal training for such conversations. Those most likely to have training included younger physicians and those caring for a racially and ethnically diverse population. Patient values and preferences were the strongest motivating factors in having advance care planning conversations, with 92% of participants rating it extremely important. Ninety‐five percent of participants reported that they supported a new Medicare fee‐for‐service benefit reimbursing advance care planning. The biggest barrier mentioned was time availability. Other barriers included not wanting a patient to give up hope and feeling uncomfortable. CONCLUSION With more than half of physicians reporting that they feel educationally unprepared, there medical school curricula need to be strengthened to ensure readiness for end‐of‐life conversations. Clinician barriers need to be addressed to meet the needs of older adults and families. Policies that focus on payment for quality should be evaluated at regular intervals to monitor their effect on advance care planning.

Older emergency department patients have high rates of serious illness and injury, are at high risk for side effects and adverse events from treatments and diagnostic tests, and in many cases, have nuanced goals of care in which pursuing the most aggressive approach is not desired. Although some forms of shared decision making (SDM) are commonly practiced by emergency physicians caring for older adults, broader use of SDM in this setting is limited by a lack of knowledge of the types of patients and conditions for which SDM is most helpful and the approaches and tools that can best facilitate this process. We describe a research agenda to generate new knowledge to optimize the use of SDM during the emergency care of older adults.

Historically, the medical subspecialties have not focused on the needs of older adults. This has changed with the implementation of initiatives to integrate geriatrics and aging research into the medical and surgical subspecialties and with the establishment of a home for internal medicine specialists within the annual American Geriatrics Society (AGS) meeting. With the support of AGS, other professional societies, philanthropies, and federal agencies, efforts to integrate geriatrics into the medical and surgical subspecialties have focused largely on training the next generation of physicians and researchers. They have engaged several subspecialties, which have followed parallel paths in integrating geriatrics and aging research. As a result of these combined efforts, there has been enormous progress in the integration of geriatrics and aging research into the medical and surgical subspecialties, and topics once considered to be geriatric concerns are becoming mainstream in medicine, but this integration remains a work in progress and will need to adapt to changes associated with healthcare reform.

As part of the 2016 Academic Emergency Medicine Consensus Conference, "Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda," a panel of representatives from the Office of Emergency Care Research, the Patient-Centered Outcomes Research Institute, the American Heart Association, the John A. Hartford Foundation, and the Emergency Care Coordination Center were assembled to discuss funding opportunities for future research in this field. This article summarizes their discussion of funding priorities and examples of successfully funded projects related to shared decision making in emergency medicine.

This article traces the funding priorities of the John A. Hartford Foundation--the largest private philanthropy in the United States dedicated to aging and health--to increase the competence of the health care workforce (physicians, nurses, and social workers) to care for our aging society. A review of the Foundation's 15-year and over $70 million investment in geriatric nursing is presented with emphasis on 2 critical factors--a focused strategy and strong partnerships--to build the nation's nursing capacity to meet the health care needs of older Americans. The evolution of Hartford's strategic goal to ensure that all nurses are skilled to care for older adults is shared to illustrate why the Foundation now funds nursing efforts in the primary areas of faculty development and curricular change. This article also underscores the importance of establishing a network of diverse partnerships and collaborations to maximize impact and create synergies.

This paper describes how the John A. Hartford Foundation sought to maximize the influence of its various geriatric nursing projects by organizing and managing them collectively as the Hartford Geriatric Nursing Initiative (HGNI). This initiative aimed to develop a shared identity, encouraged cross-pollination of efforts, convened project leaders to address opportunities and problems, launched across-project collaborations, and created tools and resources to support overall efforts. This paper ends with some reflections on the processes implemented to maximize HGNI effectiveness, particularly the importance of forging a common identity in order to encourage expanded solutions. The HGNI can serve as an example of how intersecting interests can fuel new ideas, thus helping others think more strategically about change efforts in the future.