View clinical trials related to Advance Care Planning.
Filter by:This is a pragmatic trial of SHARING Choices. Components of SHARING Choices include: 1. A letter from the clinic introducing an initiative to prepare persons and families for Advance Care Planning (ACP); 2. Access to a facilitator trained to lead ACP discussions; 3. Patient-family agenda-setting to align perspectives about the role of family and stimulate discussion about ACP; 4. Facilitated registration to the patient portal (for patient and family) as desired; 5. Education & resources about Alzheimer's Disease and Related Dementias (ADRD) for clinic staff.
This study will evaluate the impact of and response by physicians on Hospital Medicine/General Internal Medicine service to a notification identifying seriously ill patients at high risk of death within 30 days as well as within 6 months in a cluster randomized control trial.
ED GOAL is a 6-minute, motivational interviewing, advance care planning intervention. In this study, the investigators will pilot test (Part I) ED GOAL by training research nurses to demonstrate its intervention fidelity and acceptability on older adults with serious illness in the emergency department (ED). Upon demonstrating the intervention fidelity of this intervention in Part I, the investigators will collect patient-centered outcomes (Part II) of 100 older adults with serious illness after leaving the ED. Further in Part III, the investigators will conduct a survey to the participants' outpatient clinicians to find out how to optimize the care coordination from the ED to the outpatient office to facilitate advance care planning conversations.
The investigators developed a "serious game" intervention called "Who Would You Choose: Serious Fun" (WWYC) to help people consider the key qualities healthcare spokespersons should have. The intervention uses a spinner, cards, and dice, along with a smart-phone App to prompt players (using scenarios and metaphors) to choose a spokesperson whose qualities are best suited to the role. Friendly competition is encouraged by having players receive points for correct answers, and additional points for good explanations of their choices. At the end of the game, players identify a real-life spokesperson based on the qualities considered during game-play. Then, using an associated smart-phone App, the intervention will help spark communication between the player and their chosen spokesperson.
Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Drawing on the theory of narrative engagement, players assume the persona of a hospitalist and navigate a series of clinical encounters with seriously-ill patients over the age of 65. Players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a pragmatic stepped-wedge crossover phase III trial testing the efficacy of Hopewell Hospitalist for increasing ACP rates measured by ACP billing frequency.
Advance Care Planning (ACP) is a process where patients (and their families if appropriate) discuss with their doctors and nurses what may happen as their illness progresses, including how they (and their family) would like to be supported and cared for. The discussion of expectations and choices for care can then be formally recorded and used to guide and inform future care. Well documented benefits of ACP include empowering patients and their families to better understand available choices and make informed decisions regarding future care; This ensures care is based on what is important to that patient (and their family) and prepares all for the end of life. However, few people with a life limiting illness (such as cancer) have an ACP. Patients and families often find future and end of life care a difficult subject to discuss, as do doctors/nurses, who fear upsetting patients and families and who may have limited training/experience in how to prompt and record ACP discussions. This project aims to overcome the barriers in discussing ACP by using the Trajectory Touchpoint Technique. The technique utilises a range of existing service evaluation and service design methods found in "service management" and "design systems". Rich pictures are used in the form of cartoons on an electronic tablet or printed card, to enable patients/families to lead discussions. The images are simple and enable people to raise sensitive and potentially distressing topics at a pace they are comfortable with, rather than responding to numerous pre-determined questions. The technique was originally designed to explore the experiences of patients (and their families) of Hospice Care and has been successfully used in over 200 interviews, demonstrating an ability to sensitively facilitate difficult conversations whilst enabling rich and detailed discussion.
The issue Patients who are living with a life-limiting and progressive illness are often encouraged by the healthcare professionals looking after them to undergo a process called Advance Care Planning (ACP). An advance care plan is a written guide of a patient's likes, dislikes, wishes, and the treatments they would want to refuse or the rituals they would want to follow - whether during illness or at the end of life. The planning process helps patients and their relatives think about different scenarios, and the plans that would be used by medical staff if that patient becomes too ill to communicate. ACP discussions can take many forms and are often described as a process. It is accepted by healthcare professionals that ACP is useful to patients and their relatives. Research has also focussed on the positive nature of ACP, traditionally looking at issues such as how many patients have achieved their wishes and why, what makes ACP possible, and what prevents patients or healthcare professionals from starting these discussions. Some research has also looked at how patients experience the actual process of ACP itself. However, there has been little research into the effect ACP discussions can have on a patient and their relatives, or how patients react to ACP discussions. As a result, researchers and healthcare professionals do not have a full understanding of the psychological impact on patients and their families, and any resulting changes in patients' outlook, emotional state, family and clinical relationships, and their behaviours. Learning more about how patients respond to such important and challenging discussions about their care will be vital in improving healthcare professionals' understanding of how best to carry out ACP conversations, and how best to support patients and their relatives following ACP conversations. It is also important to explore not only the benefits of ACP but also the potential downsides or unexpected problems of having such a difficult conversation. What the investigators will do The aim of this study is to explore how patients are affected by discussions about their future care, and if these discussions affect how patients think or feel in themselves and what they do. The investigators will conduct qualitative interviews with patients living with a life-limiting illness who have already had ACP discussions with a healthcare professional, to explore how and in what ways ACP discussions have affected patients and their families. Qualitative interviews are semi-structured interviews that are designed to explore issues and what these mean to people in-depth, in order to gather rich data that provides insight into a person's perspectives. They are well suited to exploring subjects about which little is yet known, and also subjects which can be sensitive or challenging. Location of the study, and participation The study will be conducted from Princess Alice Hospice in Surrey, which provides both inpatient and community palliative care services to a large catchment population of approximately 1 million people, in South West London and Surrey. The investigators aim to recruit 20 participants to represent a broad range of clinical and demographic characteristics, such as age, gender, ethnicity, diagnosis and borough in which they live, in order to explore the experiences of as diverse a group as possible. Participants will be interviewed in a place convenient for them, such as in their home or the Hospice. Who the investigators are The study will be led by a clinician currently working in Palliative Care, as part of a Masters in Palliative Care, being undertaken at King's College London. The researcher will be supervised at all times by Dr. Katherine Bristowe and Dr. Lisa Brighton, of King's College London, who possess many years of experience in undertaking research among patients living with and dying from advanced disease, and their families.
Advance care planning (ACP) enables individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate. Research has shown that most Western patients express the need about what ACP entails. Ethnicity creates an important cultural impact on how people look at life and death, so that there is an influence on making decisions about end-of-life care. The moroccan ethnic group is one of the largest visible non-Western minority groups in Western countries. Studies on how ACP is perceived among patients from moroccon origin are lacking. The objective of this study is exploring the knowledge, experiences, point of views, preferences, attitudes, facilitators and barriers concerning advance care planning of older people from moroccan origin in Belgium. Semi-structured interviews (in the native moroccan/arabic language) will be used.
Advance Care Planning (ACP) is an approach to support individuals in understanding and sharing their values, treatment goals, and preferences regarding future medical care. This study aims to evaluate the clinical effectiveness of implementing a complex regional ACP program focussing on nursing homes and their related health care providers. For this purpose, a cluster-randomised controlled trial (cRCT) is being conducted in four study centres in Germany: Düsseldorf, Göttingen, Halle (Saale), and Munich. 44 nursing homes with 3,520 residents will be randomised into either an intervention group, receiving the ACP-intervention described below, or into a control group that will receive usual care. The complex ACP intervention comprises training of professional ACP facilitators (micro level), supporting organisational development in nursing homes and other relevant institutions (meso level), and moderating regional change management among a network of all related health care institutions and actors (macro level). Clinical outcomes will be measured in order to describe whether the intervention improved care consistency with care preferences. Data will be collected by two independent approaches: Firstly, participating nursing homes will provide anonymous data on all their long-term care residents of a defined time period, including the hospitalisation rate (primary outcome). The primary hypothesis will test whether the complex intervention reduces the rate of hospital admissions. A group comparison of all hospitalisations in the past 12 months is made 21 months after randomisation. Secondly, all residents who have given informed consent in the first three months of the study will be repeatedly surveyed until month 21 (or until they die earlier). Treatment decisions in the face of life-threatening illness that affect any of a list of pre-defined outcomes will be evaluated as to whether they were consistent with the residents' care preferences. If residents decease, patient-centered care in the last weeks of life will be evaluated by additional interviews with the next bereaved relative, and an involved nurse. Besides, bereaved relatives will be assessed for trauma, depression and anxiety. In addition, a process evaluation and a health economic evaluation are carried out according to Medical Research Council (MRC) recommendations.
Hospitalized patients and their families are often unprepared regarding end-of-life care. Even patients with high risk of mortality within the index admission or 30 days after admission often do not have clearly defined goals of care. This lack of clarity can create difficult scenarios for patients, their families, and care providers. Lack of communication and documentation of these goals can lead to unnecessary tests, procedures, and readmissions. By creating advanced care planning education for the hospital medicine department, a standardized note template, and EMR utilization for storage and reference of patient's goals of care documentation we aim to facilitate the conveyance of patient's wishes/preferences across different care providers and across separate encounters within the healthcare system. For this study, we will use a pre-post study design to evaluate the implementation of this quality improvement intervention.