A Telehealth Advance Care Planning Intervention in Those With Mild Cognitive Impairment or Unrecognized Dementia

Dementia Clinical Trial

— ACP  

Official title:

A Telehealth Advance Care Planning Intervention in Those With Mild Cognitive Impairment or Unrecognized Dementia (Tele Voice)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04912245
• Other study ID #: IRB00074429
• Secondary ID: U54AG063546
• Status: Completed
• Phase: N/A
• Start date: July 13, 2021
• Est. completion date: May 9, 2022

Study information

• Verified date: July 2022
• Source: Wake Forest University Health Sciences
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to pilot test a telehealth Advance Care Planning (ACP) intervention among those with either mild cognitive impairment (MCI) or unrecognized dementia. Our goal is to pilot-test and evaluate a pragmatic Telehealth ACP intervention among patients with either the diagnosis of mild cognitive impairment (MCI) or unrecognized dementia.

Description:

Telehealth has the potential to overcome barriers related to timing and travel restraints and to provide patients and their caregivers with an opportunity to discuss their goals, values, and priorities for their healthcare within their home setting. Recent studies have demonstrated patients' willingness to use telehealth and have shown that it can play an integral role in dementia care management.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 152
• Est. completion date: May 9, 2022
• Est. primary completion date: May 9, 2022
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 65 Years and older

Eligibility

Inclusion Criteria:

• Diagnosis of recognized or probable Mild cognitive impairment (MCI) or mild dementia determined by either ICD10 diagnostic codes or electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR)
• Have decisional capacity according to their primary care physician (PCP) to complete ACP
• Completed visit with their PCP within the past 12 months
• Affiliated with an Accountable Care Organization.
• English-speaking

Exclusion Criteria:

• Moderate to severe hearing loss that would preclude participating in a video or telephone intervention
• No phone number available for patient.
• Lives in a long-term care facility

Related Conditions & MeSH terms

• Advance Care Planning
• Alzheimer Disease
• Cognitive Dysfunction
• Dementia
• Mild Cognitive Impairment
• Telemedicine

Intervention

Behavioral:
• Telehealth visit
Patients with either MCI or unrecognized dementia and their care partners (if available) will be approached to participate in a telehealth Advance Care Planning (ACP) visit with a member of the patient's primary care team via either telephone or video. Patients without willing or available care partners are still eligible to participate in the study.

Locations

Country	Name	City	State
United States	Geriatric Medicine-Plaza 1 Davie	Bermuda Run	North Carolina
United States	Wake Forest Health Network Family Medicine Conover	Conover	North Carolina
United States	WFHN Family Medicine-Premier	High Point	North Carolina
United States	Wake Forest Health Network Internal Medicine	Jamestown	North Carolina
United States	WFBIK Geriatric Medicine-Kernersville	Kernersville	North Carolina
United States	WFHN Family Medicine-Thomasville	Thomasville	North Carolina
United States	Geriatric Medicine- Sticht Center	Winston-Salem	North Carolina

Sponsors (2)

Lead Sponsor	Collaborator
Wake Forest University Health Sciences	National Institute on Aging (NIA)

Country where clinical trial is conducted

United States, 

References & Publications (45)

Allore HG, Goldfeld KS, Gutman R, Li F, Monin JK, Taljaard M, Travison TG. Statistical Considerations for Embedded Pragmatic Clinical Trials in People Living with Dementia. J Am Geriatr Soc. 2020 Jul;68 Suppl 2(Suppl 2):S68-S73. doi: 10.1111/jgs.16616. — View Citation

Ayton D, Gardam M, Ward S, Brodaty H, Pritchard E, Earnest A, Krysinska K, Banaszak-Holl J, McNeil J, Ahern S. How Can Quality of Dementia Care Be Measured? The Development of Clinical Quality Indicators for an Australian Pilot Dementia Registry. J Alzheimers Dis. 2020;75(3):923-936. doi: 10.3233/JAD-191044. — View Citation

Bally KW, Krones T, Jox RJ. Advance Care Planning for People with Dementia: The Role of General Practitioners. Gerontology. 2020;66(1):40-46. doi: 10.1159/000500809. Epub 2019 Jun 18. — View Citation

Barnes DE, Zhou J, Walker RL, Larson EB, Lee SJ, Boscardin WJ, Marcum ZA, Dublin S. Development and Validation of eRADAR: A Tool Using EHR Data to Detect Unrecognized Dementia. J Am Geriatr Soc. 2020 Jan;68(1):103-111. doi: 10.1111/jgs.16182. Epub 2019 Oct 14. — View Citation

Bischoff KE, Sudore R, Miao Y, Boscardin WJ, Smith AK. Advance care planning and the quality of end-of-life care in older adults. J Am Geriatr Soc. 2013 Feb;61(2):209-14. doi: 10.1111/jgs.12105. Epub 2013 Jan 25. — View Citation

Block BL, Smith AK, Sudore RL. During COVID-19, Outpatient Advance Care Planning Is Imperative: We Need All Hands on Deck. J Am Geriatr Soc. 2020 Jul;68(7):1395-1397. doi: 10.1111/jgs.16532. Epub 2020 May 14. No abstract available. — View Citation

Bond WF, Kim M, Franciskovich CM, Weinberg JE, Svendsen JD, Fehr LS, Funk A, Sawicki R, Asche CV. Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs. J Palliat Med. 2018 Apr;21(4):489-502. doi: 10.1089/jpm.2017.0566. Epub 2017 Dec 5. — View Citation

Borda M, G, Soennesyn H, Steves C, J, Osland Vik-Mo A, Pérez-Zepeda M, U, Aarsland D: Frailty in Older Adults with Mild Dementia: Dementia with Lewy Bodies and Alzheimer's Disease. Dement Geriatr Cogn Disord Extra 2019;9:176-183. doi: 10.1159/000496537

Bossen AL, Kim H, Williams KN, Steinhoff AE, Strieker M. Emerging roles for telemedicine and smart technologies in dementia care. Smart Homecare Technol Telehealth. 2015;3:49-57. doi: 10.2147/SHTT.S59500. Epub 2015 Mar 22. — View Citation

Brinkman-Stoppelenburg A, Rietjens JA, van der Heide A. The effects of advance care planning on end-of-life care: a systematic review. Palliat Med. 2014 Sep;28(8):1000-25. doi: 10.1177/0269216314526272. Epub 2014 Mar 20. — View Citation

De Vleminck A, Morrison RS, Meier DE, Aldridge MD. Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study. J Am Med Dir Assoc. 2018 Jul;19(7):633-638. doi: 10.1016/j.jamda.2017.10.003. Epub 2017 Nov 16. — View Citation

Dong H, Robison LL, Leisenring WM, Martin LJ, Armstrong GT, Yasui Y. Estimating the burden of recurrent events in the presence of competing risks: the method of mean cumulative count. Am J Epidemiol. 2015 Apr 1;181(7):532-40. doi: 10.1093/aje/kwu289. Epub 2015 Feb 17. — View Citation

Farrell TW, Ferrante LE, Brown T, Francis L, Widera E, Rhodes R, Rosen T, Hwang U, Witt LJ, Thothala N, Liu SW, Vitale CA, Braun UK, Stephens C, Saliba D. AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond. J Am Geriatr Soc. 2020 Jun;68(6):1136-1142. doi: 10.1111/jgs.16537. — View Citation

Gabbard J, Johnson D, Russell G, Spencer S, Williamson JD, McLouth LE, Ferris KG, Sink K, Brenes G, Yang M. Prognostic Awareness, Disease and Palliative Understanding Among Caregivers of Patients With Dementia. Am J Hosp Palliat Care. 2020 Sep;37(9):683-691. doi: 10.1177/1049909119895497. Epub 2019 Dec 19. — View Citation

Gabbard J, Pajewski NM, Callahan KE, Dharod A, Foley KL, Ferris K, Moses A, Willard J, Williamson JD. Effectiveness of a Nurse-Led Multidisciplinary Intervention vs Usual Care on Advance Care Planning for Vulnerable Older Adults in an Accountable Care Organization: A Randomized Clinical Trial. JAMA Intern Med. 2021 Mar 1;181(3):361-369. doi: 10.1001/jamainternmed.2020.5950. — View Citation

Givens JL, Prigerson HG, Jones RN, Mitchell SL. Mental health and exposure to patient distress among families of nursing home residents with advanced dementia. J Pain Symptom Manage. 2011 Aug;42(2):183-91. doi: 10.1016/j.jpainsymman.2010.10.259. Epub 2011 Mar 12. — View Citation

Guisado-Fernandez E, Blake C, Mackey L, Silva PA, Power D, O'Shea D, Caulfield B. A Smart Health Platform for Measuring Health and Well-Being Improvement in People With Dementia and Their Informal Caregivers: Usability Study. JMIR Aging. 2020 Jul 23;3(2):e15600. doi: 10.2196/15600. — View Citation

Hammes BJ, Rooney BL, Gundrum JD. A comparative, retrospective, observational study of the prevalence, availability, and specificity of advance care plans in a county that implemented an advance care planning microsystem. J Am Geriatr Soc. 2010 Jul;58(7):1249-55. doi: 10.1111/j.1532-5415.2010.02956.x. — View Citation

Harrison Dening K, Sampson EL, De Vries K. Advance care planning in dementia: recommendations for healthcare professionals. Palliat Care. 2019 Feb 27;12:1178224219826579. doi: 10.1177/1178224219826579. eCollection 2019. — View Citation

Harrison KL, Hunt LJ, Ritchie CS, Yaffe K. Dying With Dementia: Underrecognized and Stigmatized. J Am Geriatr Soc. 2019 Aug;67(8):1548-1551. doi: 10.1111/jgs.15895. Epub 2019 Mar 25. No abstract available. — View Citation

Hatcher-Martin JM, Adams JL, Anderson ER, Bove R, Burrus TM, Chehrenama M, Dolan O'Brien M, Eliashiv DS, Erten-Lyons D, Giesser BS, Moo LR, Narayanaswami P, Rossi MA, Soni M, Tariq N, Tsao JW, Vargas BB, Vota SA, Wessels SR, Planalp H, Govindarajan R. Telemedicine in neurology: Telemedicine Work Group of the American Academy of Neurology update. Neurology. 2020 Jan 7;94(1):30-38. doi: 10.1212/WNL.0000000000008708. Epub 2019 Dec 4. — View Citation

Houben CHM, Spruit MA, Groenen MTJ, Wouters EFM, Janssen DJA. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014 Jul;15(7):477-489. doi: 10.1016/j.jamda.2014.01.008. Epub 2014 Mar 2. — View Citation

Kiely DK, Givens JL, Shaffer ML, Teno JM, Mitchell SL. Hospice use and outcomes in nursing home residents with advanced dementia. J Am Geriatr Soc. 2010 Dec;58(12):2284-91. doi: 10.1111/j.1532-5415.2010.03185.x. — View Citation

Lee E. Do Technology-Based Support Groups Reduce Care Burden Among Dementia Caregivers? A Review. J Evid Inf Soc Work. 2015;12(5):474-87. doi: 10.1080/15433714.2014.930362. Epub 2015 Mar 20. — View Citation

Malmgren Fange A, Schmidt SM, Nilsson MH, Carlsson G, Liwander A, Dahlgren Bergstrom C, Olivetti P, Johansson P, Chiatti C; TECH@HOME Research Group. The TECH@HOME study, a technological intervention to reduce caregiver burden for informal caregivers of people with dementia: study protocol for a randomized controlled trial. Trials. 2017 Feb 9;18(1):63. doi: 10.1186/s13063-017-1796-8. — View Citation

Mantovani E, Zucchella C, Schena F, Romanelli MG, Venturelli M, Tamburin S. Towards a Redefinition of Cognitive Frailty. J Alzheimers Dis. 2020;76(3):831-843. doi: 10.3233/JAD-200137. — View Citation

Mehta A, Kelley AS. Advance Care Planning Codes-Getting Paid for Quality Care. JAMA Intern Med. 2019 Jun 1;179(6):830-831. doi: 10.1001/jamainternmed.2018.8105. No abstract available. — View Citation

Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med. 1997 Feb 10;157(3):327-32. — View Citation

Mitchell SL, Teno JM, Intrator O, Feng Z, Mor V. Decisions to forgo hospitalization in advanced dementia: a nationwide study. J Am Geriatr Soc. 2007 Mar;55(3):432-8. doi: 10.1111/j.1532-5415.2007.01086.x. — View Citation

Nakagawa S, Johnson PCD, Schielzeth H. The coefficient of determination R2 and intra-class correlation coefficient from generalized linear mixed-effects models revisited and expanded. J R Soc Interface. 2017 Sep;14(134):20170213. doi: 10.1098/rsif.2017.0213. Epub 2017 Sep 13. — View Citation

Oliveira IR, Molenberghs G, Demetrio CG, Dias CT, Giolo SR, Andrade MC. Quantifying intraclass correlations for count and time-to-event data. Biom J. 2016 Jul;58(4):852-67. doi: 10.1002/bimj.201500093. Epub 2016 Feb 22. — View Citation

Piers R, Albers G, Gilissen J, De Lepeleire J, Steyaert J, Van Mechelen W, Steeman E, Dillen L, Vanden Berghe P, Van den Block L. Advance care planning in dementia: recommendations for healthcare professionals. BMC Palliat Care. 2018 Jun 21;17(1):88. doi: 10.1186/s12904-018-0332-2. — View Citation

Rondeau V, Marzroui Y, Gonzalez JR. frailtypack: An R Package for the Analysis of Correlated Survival Data with Frailty Models Using Penalized Likelihood Estimation or Parametrical Estimation. 2012. 2012;47(4):28.

Sellars M, Chung O, Nolte L, Tong A, Pond D, Fetherstonhaugh D, McInerney F, Sinclair C, Detering KM. Perspectives of people with dementia and carers on advance care planning and end-of-life care: A systematic review and thematic synthesis of qualitative studies. Palliat Med. 2019 Mar;33(3):274-290. doi: 10.1177/0269216318809571. Epub 2018 Nov 8. — View Citation

Shigekawa E, Fix M, Corbett G, Roby DH, Coffman J. The Current State Of Telehealth Evidence: A Rapid Review. Health Aff (Millwood). 2018 Dec;37(12):1975-1982. doi: 10.1377/hlthaff.2018.05132. — View Citation

Sinuff T, Dodek P, You JJ, Barwich D, Tayler C, Downar J, Hartwick M, Frank C, Stelfox HT, Heyland DK. Improving End-of-Life Communication and Decision Making: The Development of a Conceptual Framework and Quality Indicators. J Pain Symptom Manage. 2015 Jun;49(6):1070-80. doi: 10.1016/j.jpainsymman.2014.12.007. Epub 2015 Jan 24. — View Citation

Sudore RL, Heyland DK, Lum HD, Rietjens JAC, Korfage IJ, Ritchie CS, Hanson LC, Meier DE, Pantilat SZ, Lorenz K, Howard M, Green MJ, Simon JE, Feuz MA, You JJ. Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus. J Pain Symptom Manage. 2018 Feb;55(2):245-255.e8. doi: 10.1016/j.jpainsymman.2017.08.025. Epub 2017 Sep 1. — View Citation

Sugimoto T, Ono R, Kimura A, Saji N, Niida S, Sakai T, Rakugi H, Toba K, Sakurai T. Impact of Cognitive Frailty on Activities of Daily Living, Cognitive Function, and Conversion to Dementia Among Memory Clinic Patients with Mild Cognitive Impairment. J Alzheimers Dis. 2020;76(3):895-903. doi: 10.3233/JAD-191135. — View Citation

Teno JM, Gruneir A, Schwartz Z, Nanda A, Wetle T. Association between advance directives and quality of end-of-life care: a national study. J Am Geriatr Soc. 2007 Feb;55(2):189-94. doi: 10.1111/j.1532-5415.2007.01045.x. — View Citation

Teno JM, Mitchell SL, Kuo SK, Gozalo PL, Rhodes RL, Lima JC, Mor V. Decision-making and outcomes of feeding tube insertion: a five-state study. J Am Geriatr Soc. 2011 May;59(5):881-6. doi: 10.1111/j.1532-5415.2011.03385.x. Epub 2011 May 3. — View Citation

Tousi B. Dementia Care in the Time of COVID-19 Pandemic. J Alzheimers Dis. 2020;76(2):475-479. doi: 10.3233/JAD-200461. — View Citation

Volhard T, Jessen F, Kleineidam L, Wolfsgruber S, Lanzerath D, Wagner M, Maier W. Advance directives for future dementia can be modified by a brief video presentation on dementia care: An experimental study. PLoS One. 2018 May 24;13(5):e0197229. doi: 10.1371/journal.pone.0197229. eCollection 2018. — View Citation

Weiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, Boynton MH, Halko H. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017 Aug 29;12(1):108. doi: 10.1186/s13012-017-0635-3. — View Citation

Wilkinson T, Ly A, Schnier C, Rannikmae K, Bush K, Brayne C, Quinn TJ, Sudlow CLM; UK Biobank Neurodegenerative Outcomes Group and Dementias Platform UK. Identifying dementia cases with routinely collected health data: A systematic review. Alzheimers Dement. 2018 Aug;14(8):1038-1051. doi: 10.1016/j.jalz.2018.02.016. Epub 2018 Apr 3. — View Citation

Williams K, Blyler D, Vidoni ED, Shaw C, Wurth J, Seabold D, Perkhounkova Y, Van Sciver A. A randomized trial using telehealth technology to link caregivers with dementia care experts for in-home caregiving support: FamTechCare protocol. Res Nurs Health. 2018 Jun;41(3):219-227. doi: 10.1002/nur.21869. Epub 2018 Mar 5. — View Citation

* Note: There are 45 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Patient/Care Partner Agreeing to Participate	Study will measure the amount of patient or patient-care partner dyads who agree to participate.	Baseline to Month 9
Primary	Number of Participants With Telehealth Advance Care Planning (ACP) Completed	Study will measure the amount of patients or patient-care partner dyads who complete the ACP telehealth intervention.	month 9
Secondary	Number of Participants With One or More Advance Care Planning (ACP) Discussions	Study will measure the number of ACP discussions documented in the electronic health record.	month 9
Secondary	Number of Participants Who Used One or More Advance Care Planning (ACP) Billing Codes	Study will measure the usage of ACP billing codes (99497 and 99498).	month 9
Secondary	Quality of Advance Care Planning (ACP) Discussion Scores	Discussion quality will be operationalized using a scoring system derived from the ACP Wise documentation program. Score range of 0 (indicating no advance care planning questions answered) to 9 (indicating nine advance care planning questions answered). High-quality ACP discussions will be defined as addressing =4 out of 9 core components in the ACP discussion, with 1 point assigned if the following factors were addressed as part of the ACP discussion: Disease understanding, health-related goals, what matters most in their life, important milestones, health-related worries, named surrogate decision-maker, unacceptable states at the end-of-life (e.g. being in a coma, etc.), goals if their health was to worsen, and documentation of code status.	month 9

External Links

•   2019 Tech Trends and the 50+
•   Centers for Medicare & Medicaid (2020) Medicare Telemedicine Health Care Provider Fact Sheet
•   Telehealth Survey