Family Centered Advanced Care Planning for Adolescents With HIV/AIDS and Their Families

HIV Infections Clinical Trial

Official title:

Family Centered Advanced Care Planning (FCACP)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00723476
• Other study ID #: R34MH072541
• Secondary ID: R34MH072541
• Status: Completed
• Phase: N/A
• First received: July 25, 2008
• Last updated: May 19, 2015
• Start date: September 2005
• Est. completion date: September 2008

Study information

• Verified date: May 2015
• Source: Children's Research Institute
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Federal Government
• Study type: Interventional

Clinical Trial Summary

This study will examine the efficacy of Family Centered Advance Care Planning in enhancing quality of life, integrating effective end-of-life care, and preventing depression and anxiety among HIV infected adolescents and their family members.

Description:

More than 30,000 adolescents in the United States die annually from the effects of chronic illnesses. The anxiety from facing a terminal illness often hinders adolescents in making decisions about their own end-of-life (EOL) care. Although minors' preferences are not legally binding, legislature, research, and professional guidelines all recommend that adolescent patients become involved in EOL decisions as part of routine intervention while they are stable. Family Centered Advance Care Planning (FCACP) is an intervention that facilitates EOL discussion among adolescents, their families, and their care providers. This pilot study will examine FCACP's effects on adaptive coping, psychological adjustment, quality of life, and plans and actions in HIV infected adolescents. The study will also provide feedback used for improving the FCACP Web site.

This study will include HIV or AIDS infected adolescents ranging in age from 14 to 21 who will jointly enroll with a selected surrogate older than 21. The adolescent/surrogate pairs will be randomly assigned to receive either the FCACP intervention or a health education control intervention. Pairs not immediately ready to participate will form an observational group. Pairs in the FCACP group will meet with a trained facilitator weekly for a 60- to 90-minute session for a total of 3 weeks. During the first session, participants will take the Lyon Advance Care Planning Survey. The second session will consist of the Respecting Choices Interview, where patients will discuss treatment preferences. The Family Problem-Solving session will be last, culminating with the patient's completion of an advance directive. The control groups will follow the same meeting schedule, but will receive health education sessions, not FCACP sessions. Standardized self-report measures will be administered upon entry, after completion of the sessions, and at a 3-month follow up. Usage data will also be analyzed regarding feasibility and acceptability of FCACP as a standard treatment.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 82
• Est. completion date: September 2008
• Est. primary completion date: August 2008
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Both
• Age group: 12 Years and older

Eligibility

Inclusion Criteria:

Adolescent Eligibility Criteria:

• Diagnosed with HIV/AIDS

• Between the ages of 14 and 21 years

• Aware of his or her HIV status

• Able to speak English

• Intelligence Quotient (IQ) greater than 69 (all patients have IQ testing results in chart as part of standard of care)

• Consent from the legal guardian if between ages of 14 and 17

• Consent from the surrogate if between ages of 18 and 21

• Assent from adolescent aged 14 to 17

• Consent from adolescent aged 18 to 21

Legal Guardian Eligibility Criteria (for guardians of adolescents aged 14 to 17):

• Adolescent is willing to discuss problems related to HIV with him/her

• Age 21 or older

• Able to speak English

• Legal guardian

Surrogate Eligibility Criteria:

• Selected by adolescent aged 18 to 21

• Age 21 or older

• Willing to discuss problems related to HIV and EOL

• Able to speak English

Exclusion Criteria For All Participants:

• Depression in the moderate to severe range on Beck Depression Inventory

• Unaware of HIV status of self, or if proxy, of adolescent

• Presence of HIV dementia, determined at screening using the HIV Dementia Scale

• Active homicidality or suicidality, determined at baseline screening by psychologist or researcher

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• HIV Infections

Intervention

Behavioral:
• Family Centered Advanced Care Planning (FCACP) sessions
FCACP will include three 60- to 90-minute weekly sessions. Sessions consisting of structured conversations with HIV infected adolescents, their proxies, and trained facilitators will aim to enhance quality of life by integrating effective end-of-life (EOL) care and minimizing depression and anxiety. The three sessions will consist of a structured EOL survey, an FCACP interview, and a family problem-solving lesson.
• Health education control sessions
Health education control sessions will include three 60- to 90-minute sessions and will involve adolescents with HIV/AIDS and their proxies. Topics covered during sessions will include developmental history, planning for the future, and safety tips.

Locations

Country	Name	City	State
United States	Children's Research Institute	Washington	District of Columbia

Sponsors (2)

Lead Sponsor	Collaborator
Maureen Lyon	National Institute of Mental Health (NIMH)

Country where clinical trial is conducted

United States, 

References & Publications (5)

Garvie PA, He J, Wang J, D'Angelo LJ, Lyon ME. An exploratory survey of end-of-life attitudes, beliefs, and experiences of adolescents with HIV/AIDS and their families. J Pain Symptom Manage. 2012 Sep;44(3):373-85.e29. doi: 10.1016/j.jpainsymman.2011.09.022. Epub 2012 Jul 7. — View Citation

Lyon ME, Garvie P, He J, Malow R, McCarter R, D'Angelo LJ. Spiritual well-being among HIV-infected adolescents and their families. J Relig Health. 2014 Jun;53(3):637-53. doi: 10.1007/s10943-012-9657-y. — View Citation

Lyon ME, Garvie PA, Briggs L, He J, Malow R, D'Angelo LJ, McCarter R. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE) planning - anxiety, depression, quality of life. HIV AIDS (Auckl). 2010;2:27-37. Epub 2010 Feb 18. — View Citation

Lyon ME, Garvie PA, Briggs L, He J, McCarter R, D'Angelo LJ. Development, feasibility, and acceptability of the Family/Adolescent-Centered (FACE) Advance Care Planning intervention for adolescents with HIV. J Palliat Med. 2009 Apr;12(4):363-72. doi: 10.1089/jpm.2008.0261. — View Citation

Lyon ME, Garvie PA, McCarter R, Briggs L, He J, D'Angelo LJ. Who will speak for me? Improving end-of-life decision-making for adolescents with HIV and their families. Pediatrics. 2009 Feb;123(2):e199-206. doi: 10.1542/peds.2008-2379. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Improved mental health outcomes (e.g., decreased anxiety, depression), improved quality of life, and improved plans and actions (e.g., communication with primary health care provider, an advanced directive in the medical chart)		Measured at Month 3 of follow-up	No
Secondary	Improved congruence about end-of-life care between adolescents and family, using the Statement of Treatment Preferences		Measured immediately post-treatment	No