Today’s podcast is a follow up to our 2018 podcast with Randy Curtis about the Jumpstart intervention.  On that podcast he and collaborators tested a combined patient and clinician facing communication priming intervention to promote goals of care conversations.  Today we discuss a new paper in JAMA that tests a stripped down version of the clinician only facing intervention in a pragmatic randomized trial for older adults with serious illness and those 80+.  They found a difference of 4% in documented goals of care discussions.  Is 4% meaningful?  You’ll have to decide for yourself, though it likely is meaningful on a population basis.  Intriguingly, in a sub-analysis, they found a much higher rate of difference among minoritized older adults - more like 10%.  In a compelling editorial, Doug White and Sarah Anderson argue that even a 4% difference is important on a population basis, and that higher rates of difference among minoritized older adults demonstrate the potential of the intervention to address long-standing disparities in goals of care. Randy Curtis was first author of the JAMA paper.  Randy died February 26, 2023.  We begin today’s podcast asking his co-authors Erin Kross, Bob Lee, and Ruth Engelberg, all from the University of Washington and the Cambia Palliative Care Center of Excellence, to reflect on Randy and his dedication to seeing this work completed while living with ALS.  Eric and I also reflect on the podcast Randy generously did with us on his experience living with and studying serious illness.  We have lost a giant.  He is sorely missed, and celebrated. And…the guests torture me about songs I can’t play with the word Jump. -@AlexSmithMD