Implementation of a Standardized Tracheostomy Education Discharge Protocol

Head and Neck Cancer Clinical Trial

Official title:

Implementation of a Standardized Tracheostomy Education Discharge Protocol

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT04741256
• Other study ID #: CASE4320
• Status: Not yet recruiting
• Phase: N/A
• Start date: April 2024
• Est. completion date: January 1, 2025

Study information

• Verified date: November 2023
• Source: Case Comprehensive Cancer Center
• Contact: Rod Rezaee, MD
• Phone: 1-800-641-2422
• Email: CTUReferral[@]UHhospitals.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to identify and establish a safe and effective tracheostomy teaching protocol for caregivers. Results of this study will help in the development of a discharge protocol that allows for caregiver confidence and activation in tracheostomy care for patients.

Description:

This is a 3-phase, prospective controlled cohort study . The first "pre-implementation" phase will include assessment of healthcare utilization costs of tracheostomy patients currently and nursing perspective on current caregiver tracheostomy knowledge. The second "protocol" phase will include assessment of the necessity, acceptability, feasibility, fidelity, safety and effectiveness of a standardized pathway and assessment of the caregiver's activation. The third "post-implementation" phase will involve assessment of post-implementation tracheostomy-related healthcare utilization costs and nursing perspective on caregiver tracheostomy knowledge.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 75
• Est. completion date: January 1, 2025
• Est. primary completion date: July 1, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

Patient participants:

• Diagnosis of malignancy of the head and neck requiring reconstruction and temporary tracheostomy
• No previous record of tracheostomy
• Has an identified family caregiver who is willing to participate
• Has the tracheostomy in place for at least 10 days after discharge

Caregiver participants:

• Family member or friend, who is 18 years or older, of an adult patient described above
• Identified by the patient as his/her primary caregiver who is providing daily assistance

Exclusion Criteria:

• Patients who do not have a caregiver
• Caregivers who are illiterate.
• Caregivers with previous tracheostomy experience.
• Patients who are decannulated from tracheostomy prior to discharge.
• Patients discharged to a skilled nursing facility at the time of discharge.
• Patients who are tolerating continuous tracheostomy capping at time of discharge

Related Conditions & MeSH terms

• Head and Neck Cancer
• Head and Neck Neoplasms

Intervention

Behavioral:
• Education booklet & standardized discharge training
Tracheostomy education booklet and tracheostomy teaching performed by nurses during hospitalization as dictated by the booklet.

Locations

Country	Name	City	State
United States	University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center	Cleveland	Ohio

Sponsors (1)

Lead Sponsor	Collaborator
Case Comprehensive Cancer Center

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Patient-Caregiver Activation Survey scores	Caregiver activation in managing their family members' tracheostomy after implementation of a standardized discharge program as measured by the Patient-Caregiver Activation Survey. This is a validated survey assessing caregiver consisting of 13 questions designed to determined confidence in taking care of their loved one. Scores range from 4 to 52, with higher score indicates higher degree of caregiver activation	At time of surgery, an average of 15 minutes
Primary	Patient-Caregiver Activation Survey scores	Caregiver activation in managing their family members' tracheostomy after implementation of a standardized discharge program as measured by the Patient-Caregiver Activation Survey. This is a validated survey assessing caregiver consisting of 13 questions designed to determined confidence in taking care of their loved one. Scores range from 4 to 52, with higher score indicates higher degree of caregiver activation	At discharge (an average of 7 days after surgery), an average of 15 minutes
Primary	Patient-Caregiver Activation Survey scores	Caregiver activation in managing their family members' tracheostomy after implementation of a standardized discharge program as measured by the Patient-Caregiver Activation Survey. This is a validated survey assessing caregiver consisting of 13 questions designed to determined confidence in taking care of their loved one. Scores range from 4 to 52, with higher score indicates higher degree of caregiver activation	At first follow-up (1 week after discharge), an average of 15 minutes
Secondary	Feasibility Questionnaire scores	The feasibility questionnaire evaluates the necessity, acceptability and feasibility of the of the implementation of a standardized discharge program. Questions are related to readiness and willingness to participate in tracheostomy care. It will assess feasibility in attending tracheostomy teaching sessions by nurses and their baseline comfort in tracheostomy care and their enthusiasm in learning tracheostomy care. Questionnaire consists of 12 questions, with scores ranging from 12 to 60, with higher scores indicating higher feasibility of tracheostomy protocol implementation.	At time of surgery, an average of 15 minutes
Secondary	Patient Reported Outcomes Measurement Information System (PROMIS) short form scores	Safety, as measured by the PROMIS scores - 7-item questionnaire that assess self-reported anxiety in the family caregiver. A higher score correlates with a higher level of anxiety. Scores range from 7 to 25, with higher scores indicating a greater severity of anxiety	At time of surgery, an average of 15 minutes
Secondary	Patient Reported Outcomes Measurement Information System (PROMIS) short form scores	Safety, as measured by the PROMIS scores - 7-item questionnaire that assess self-reported anxiety in the family caregiver. A higher score correlates with a higher level of anxiety. A higher score correlates with a higher level of anxiety. Scores range from 7 to 25, with higher scores indicating a greater severity of anxiety	At discharge (an average of 7 days after surgery), an average of 15 minutes
Secondary	Patient Reported Outcomes Measurement Information System (PROMIS) short form scores	Safety, as measured by the PROMIS scores - 7-item questionnaire that assess self-reported anxiety in the family caregiver. A higher score correlates with a higher level of anxiety. A higher score correlates with a higher level of anxiety. Scores range from 7 to 25, with higher scores indicating a greater severity of anxiety	At first follow-up (1 week after discharge), an average of 15 minutes
Secondary	Preparedness Caregiver Scale (PCS)	PCS scores - Response categories correspond to the level of preparedness. Scale consists of 9 questions, with scores ranging from 0 to 4 with high score indicating the more prepared the caregiver feels for caregiving.	At discharge (an average of 7 days after surgery), an average of 15 minutes
Secondary	Preparedness Caregiver Scale (PCS)	PCS scores - Response categories correspond to the level of preparedness. Scale consists of 9 questions, with scores ranging from 0 to 4 with high score indicating the more prepared the caregiver feels for caregiving.	At first follow-up (1 week after discharge), an average of 15 minutes
Secondary	Tracheostomy Care Competency Assessment	Effectiveness will be measured with the tracheostomy care competency assessment. This survey will be an individual's subjective assessment of his or her knowledge of tracheostomy care. A 5-point Likert scale will be used from 1 "strongly disagree" to 5 "strongly agree" and assess different aspects of tracheostomy care outlined during their tracheostomy teaching provided by nurses. This assessment includes 12 questions with scores ranging from from 12 to 60 with higher scores indicating higher competency.; Results form pre-implementation to post-implementation will be compared using a paired t-test or McNemar tes	At discharge (an average of 7 days after surgery), an average of 15 minutes
Secondary	Tracheostomy Care Competency Assessment	Effectiveness will be measured with the tracheostomy care competency assessment. This survey will be an individual's subjective assessment of his or her knowledge of tracheostomy care. A 5-point Likert scale will be used from 1 "strongly disagree" to 5 "strongly agree" and assess different aspects of tracheostomy care outlined during their tracheostomy teaching provided by nurses. This assessment includes 12 questions with scores ranging from from 12 to 60 with higher scores indicating higher competency.; Results form pre-implementation to post-implementation will be compared using a paired t-test or McNemar tes	At first follow-up (1 week after discharge), an average of 15 minutes
Secondary	Average tracheostomy-related healthcare utilization costs	Effectiveness will be measured with the tracheostomy care competency assessment. This survey will be an individual's subjective assessment of his or her knowledge of tracheostomy care. A 5-point Likert scale will be used from 1 "strongly disagree" to 5 "strongly agree" and assess different aspects of tracheostomy care outlined during their tracheostomy teaching provided by nurses. This assessment includes 12 questions with scores ranging from from 12 to 60 with higher scores indicating higher competency.; Results form pre-implementation to post-implementation will be compared using a paired t-test or McNemar tes	Pre-implementation (up to 6 months prior to surgery)
Secondary	Average tracheostomy-related healthcare utilization costs	Average pre and post-implementation tracheostomy-related healthcare utilization costs	Post-implementation, 30 days after discharge
Secondary	Nursing survey	Effectiveness will be measured with the Nursing Survey scores. This is an 11 question survey designed to capture the amount of phone calls nurses receive regarding tracheostomy related questions over the last 6 months.; Results form pre-implementation to post-implementation will be compared using a paired t-test or McNemar tes	Pre-implementation (up to 6 months prior to surgery)
Secondary	Nursing survey	Effectiveness will be measured with the Nursing Survey scores. This is an 11 question survey designed to capture the amount of phone calls nurses receive regarding tracheostomy related questions over the last 6 months.; Results form pre-implementation to post-implementation will be compared using a paired t-test or McNemar tes	Post-implementation, 30 days after discharge
Secondary	Number of emergency department visits, urgent care or outpatient appointments post-discharge	Number of emergency department visits, urgent care or outpatient appointments, relating to post-discharge assessment of feasibility and safety of intervention	Post-implementation, 30 days after discharge
Secondary	Average number of tracheostomy-related phone calls per week post-discharge	Post-discharge assessment of feasibility, as measured by average number of tracheostomy-related phone calls per week	Post-implementation, 30 days after discharge