Advanced Cancer Clinical Trial
Official title:
Population-based Comparison of Evidence-based, Patient-centered Advance Care Planning Interventions on Advance Directive Completion, Goal Concordant Care and Caregiver Outcomes for Patients With Advanced Illness
Verified date | May 2024 |
Source | University of California, Los Angeles |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Using a cluster randomized design at the clinic level, this project will implement and test three real-world, scalable advance care planning interventions among primary care clinics across three University of California health systems. Seriously ill patients identified using data from the electronic health record will receive (1) an advance directive with targeted messaging, (2) intervention 1 plus prompting to engage with the Prepare For Your Care website, or (3) intervention 2 plus engagement from a clinic-based facilitator. A Research cohort of patients will provide complete surveys at baseline, 12 and 24 months. The main outcomes are advance directive completion among the population cohort and goal concordant care among the Research cohort at 12 months.
Status | Active, not recruiting |
Enrollment | 6400 |
Est. completion date | September 15, 2024 |
Est. primary completion date | June 30, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Population cohort Inclusion Criteria - At least 2 visits to a primary care clinic in the health system in the past 12 months - Serious illness according to an algorithm using electronic health record data including patients with: advanced cancer, advanced heart failure, advanced chronic obstructive pulmonary disease, decompensated liver disease, end stage renal disease, amyotrophic lateral sclerosis, or was a vulnerable elder with a serious illness Exclusion Criteria: None. Research cohort: Derived from the population cohort plus: Inclusion Criteria - Speak English or Spanish - Provide informed consent Exclusion Criteria - Too cognitively impaired to provide informed consent - Primary care physician identifies that survey may be harmful |
Country | Name | City | State |
---|---|---|---|
United States | University of California, Irvine | Irvine | California |
United States | University of California at Los Angeles | Los Angeles | California |
United States | University of California at San Francisco | San Francisco | California |
Lead Sponsor | Collaborator |
---|---|
University of California, Los Angeles | University of California, Irvine, University of California, San Francisco |
United States,
Walling AM, Sudore RL, Bell D, Tseng CH, Ritchie C, Hays RD, Gibbs L, Rahimi M, Sanz J, Wenger NS. Population-Based Pragmatic Trial of Advance Care Planning in Primary Care in the University of California Health System. J Palliat Med. 2019 Sep;22(S1):72-81. doi: 10.1089/jpm.2019.0142. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Healthcare utilization among decedents | Hospitalization, ICU care and ER visits within 30 days of death will be compared among decedents of the three study arms using regression models to account for patients clustered within clinics including covariates of patient age, gender, race/ethnicity, serious illness category, clinic baseline advance directive completion rate, study site, time, study arm, and study arm-time interaction. | 24 months | |
Other | Research cohort: advance care planning process, 12 months | Advance care planning level of engagement and conversations based on survey (Sudore RL, Stewart AL, Knight SJ, McMahan RD, Feuz M, Miao Y, Barnes DE. Development and validation of a questionnaire to detect behavior change in multiple advance care planning behaviors. PLoS One. 2013;8(9):e72465). | 12 months | |
Other | Research cohort: advance care planning process, 24 months | Advance care planning level of engagement and conversations based on validated survey (Sudore RL, Stewart AL, Knight SJ, McMahan RD, Feuz M, Miao Y, Barnes DE. Development and validation of a questionnaire to detect behavior change in multiple advance care planning behaviors. PLoS One. 2013;8(9):e72465). | 24 months | |
Primary | Advance directive completion, 12 months | Proportion of patients that have advance care planning documentation (enduring advance directive, POLST or out-of-hospital DNR form in the electronic health record) at 12 months (or death) compared to baseline. Baseline date defined as the clinic intervention start date. Intention to treat analysis will use logistic regression models to account for patients clustered within clinics including covariates of patient age, gender, race/ethnicity, serious illness category, clinic baseline advance directive completion rate, study site, time, study arm, and study arm-time interaction. | 12 months or death | |
Primary | Research cohort: Goal concordant care, cross-sectional survey, 12 months | Goal concordant care measured by patient/caregiver reports of receipt of preference concordant care based on questions from SUPPORT (Teno JM, Fisher ES, Hamel MB, Coppola K, Dawson NV. Medical Care Inconsistent with Patients' Treatment Goals: Association with 1-Year Medicare Resource Use and Survival. J Am Geriatr Soc. 2002;50(3):496-500. doi:10.1046/j.1532-5415.2002.50116.) | 12 months or death | |
Secondary | New advance directive completion, 12 months | Advance care planning documentation (enduring advance directive, POLST or out-of-hospital DNR form in the electronic health record) among patients with no advance care planning documentation in the past three years. Baseline date defined as receipt of intervention. "As treated" analysis will use logistic regression models to account for patients clustered within clinics including covariates of patient age, gender, race/ethnicity, serious illness category, clinic baseline advance directive completion rate, study site, time, study arm, and study arm-time interaction. | 12 months or death | |
Secondary | Research cohort: Report of end of life care | Caregiver report of quality of end of life care among decedents based on the modified Bereaved Family Survey | 24 months | |
Secondary | Advance directive completion, 24 months | Proportion of patients that have advance care planning documentation | 24 months or death | |
Secondary | New advance directive completion, 24 months | Advance care planning documentation | 24 months or death | |
Secondary | Research cohort: Goal concordant care, cross-sectional survey, 24 months | Goal concordant care measured by patient/caregiver reports of receipt of preference concordant care based on questions from SUPPORT (Teno JM, Fisher ES, Hamel MB, Coppola K, Dawson NV. Medical Care Inconsistent with Patients' Treatment Goals: Association with 1-Year Medicare Resource Use and Survival. J Am Geriatr Soc. 2002;50(3):496-500. doi:10.1046/j.1532-5415.2002.50116.) | 24 months or death | |
Secondary | Research cohort: Goal concordant care, comparison of care to preferences | Goal concordant care measured as match of care receipt to future care preference based on survey | 24 months or death | |
Secondary | Research cohort: Goal concordant care, post-mortem survey | Goal concordant care measured as caregiver post-mortem report goal concordant care (Teno JM, Freedman VA, Kasper JD, Gozalo P, Mor V. Is care for the dying improving in the United States? J Palliat Med. 2015;18(8):662-6). | 24 months or death |
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