Table 3.

Detailed description of core functions and forms

Core function (purpose)	Related forms (activities)	Notes for future adaptation
Core Function 1: Do not lead the conversation by mentioning the “h” word [hospice], start the conversation by discussing care goals, needs, and preferences. End the conversation by talking about hospice as a solution to self-identified needs and goals. Purpose this serves: Per the Casarett evidence-based intervention (EBI) theory of change, the driving causal mechanism is the reframing of the conversation. Thus, the purpose this core function serves is that the reframing shifts the conversation to a topic the clinician feels comfortable discussing and will be less likely to delay/avoid.	Activities related to the framing of the conversation: In the Casarett EBI, the conversation was introduced as one about patient care goals, needs, and preferences and the exact form (script/wording) was detailed in the intervention protocol.	Because the core function is the reframing of the conversation, the exact script introducing the screening conversation could be adapted as long as the adaptations still preserve the related core function, which was the fact that you are starting by discussing a “neutral” topic, other than hospice/end-of-life care. Other aspects of form that were unrelated to this core function include the screening questions themselves, as well as who is asking the questions. As unrelated forms, these activities could also be adapted without the need to ensure that any adaptations to form are fulfilling a core function.
Core Function 2: Standardize the timing of the conversation, as well as the eligible patient population for the conversation. Purpose this serves: Per the Casarett EBI theory of change, standardizing the timing and target population for the conversation eliminates the need to rely on clinical judgment and a precipitating event, thus improving the timing of the conversation and subsequent referrals to hospice. Thus, this core function serves the purpose of removing the need to rely on clinical judgment alone, decreasing the risk for delaying the conversation.	In the Casarett EBI intervention, eligible patients included all nursing home residents assigned to the treatment group who were not already on hospice. Timing of the conversation was to happen after the mailer was sent to the patient’s surrogate.	The form (exact timing and exact patient eligibility criteria) can be adapted, provided the core function is still met (that there are some clearly defined parameters around who is eligible and when the conversations should occur so that you are not relying entirely on clinical judgment to decide when to initiate the screening conversation and with whom). Unrelated forms include how eligible patients were identified and how follow-up and referrals to hospice were initiated.