Table 2.

Intervention domains and related outcome measures

Domain	Intervention approach	Outcome measures
Overall palliative approach	• Utilize core values in all messaging (cultural tailoring) • Importance of family (familia or familism) • Personal Connections based on trust (confianza) • Value/build strong interpersonal connections (personalismo)	FACT-G PNPOM Aggressive care at the very end of life
Advance care planning (ACP)	• Review educational materials about advance directives (AD) • Leave a blank copy of AD with participant • Help patient complete a goals/values history • Help participant complete an AD • Reinforce benefits and limitations of ACP • Ensure AD reaches medical record • Review AD documents	ACP Engagement survey AD documentation in EHR
Pain and symptom management	• Review educational materials about pain and symptom assessment and management; discuss participant’s current symptom level • Discuss strategy to talk about pain and symptom related issues with primary care provider • Facilitate achieving adequate pain and symptom control by empowering participant through role playing • Explore and help resolve barriers and problems with pain and symptom management • Review current pain and symptom management plan; explore and help resolve barriers	BPI ESAS-r
Hospice utilization	• Review educational materials about palliative care and general goals of hospice care • Discuss goals and values history with participant • Start working on a plan for palliative care that incorporates values and goals of participant • Review plan for palliative care • Referral if appropriate and requested by participant	Hospice utilization: • Enrollment • Length of Stay