An Advance Care Planning Programme for Persons With Early Stage Dementia in the Community

Mild Cognitive Impairment Clinical Trial

Official title:

Effects of an Advance Care Planning Programme for Persons With Early Stage Dementia in the Community: A Quasi-experimental Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04491578
• Other study ID #: HMRF 03180198
• Status: Completed
• Phase: N/A
• Start date: January 9, 2021
• Est. completion date: October 31, 2022

Study information

• Verified date: March 2023
• Source: Hong Kong Metropolitan University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Advance care planning (ACP) has been widely advocated for persons with early stage dementia (PWEDs) and persons with mild cognitive impairment (MCI). This proposed study attempts to promote the uptake of ACP for this population and their family caregivers in the community and to examine the effects of an ACP programme "Have a Say" for this population. It is hypothesized that participants received the intervention will be more engaged in ACP and their dyadic concordance on end-of-life care preference with their family caregivers will be higher after the intervention.

Description:

This study aims to evaluate the impacts of an advance care planning (ACP) programme "Have a Say" for persons with early stage dementia (PWEDs) or MCI and their family caregivers in the community. A quasi-experimental study with repeated blinded outcome assessment will be conducted to assess the effects of an ACP programme on dyads of PWEDs or persons with MCI and their family caregivers recruited from elderly community centres. Individuals who have a clinical diagnosis of any form of dementia at the early stage or MCI or have a Global Deterioration Score (GDS) 3 or 4 will be eligible to this study. Participants will receive a 4-session ACP programme. It includes an educational component, guided reflection and ACP discussion through a series of group-based activity and dyadic discussion delivered by trained ACP facilitator and guided by an ACP booklet. Dyads of participants will be provided with information about the trajectory of dementia, their future healthcare needs and caring options. Their values and care preferences on future care will be elicited in a consistent manner. They will be supported to have an individualized ACP discussion. The primary study outcome is the ACP engagement level of PWEDs. Secondary outcome is the dyadic concordance on end-of-life care preference. Adverse outcomes such as depression and caregivers' burden will also be evaluated. Data collection will be conducted at baseline, immediately after, and one-month after the intervention.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 100
• Est. completion date: October 31, 2022
• Est. primary completion date: August 31, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 55 Years and older

Eligibility

Inclusion Criteria:

• aged 55 years or over;
• being Chinese,
• being a Cantonese speaker,
• having a Global Deterioration Scale score 3 or 4,
• having a designated family caregiver willing to participate in this study

Exclusion Criteria:

• non-communicable,
• mentally incompetent,
• received an ACP intervention,
• have previously signed an advance directive,
• have other life-limiting chronic illnesses with a life expectancy of less than 6 months.

Related Conditions & MeSH terms

• Cognitive Dysfunction
• Dementia
• Dementia Mild
• Mild Cognitive Impairment

Intervention

Behavioral:
• ACP programme "Have a Say"
Each dyad of participants will receive a 4-session ACP programme, which consists of educational components, guided reflection, and dyadic ACP discussion, guided by ACP facilitators and an ACP booklet. It is composed of 2 group-based sessions and 2 dyadic discussions. One hour for each session. The group-based sessions are nurse-led, in which dyads of participants will be provided with information about the trajectory of dementia, their future healthcare needs and caring options. Their values and care preferences on future care will be elicited in a consistent manner. The dyadic sessions are led by trained ACP facilitator. Dyads of participants will be supported to have an individualized ACP discussion. By the end of the programme, each dyad of participants will be given an ACP booklet documenting the ACP process.

Locations

Country	Name	City	State
Hong Kong	HKSKH Lok Man Alice Kwok Integrated Service Centre	Kowloon
Hong Kong	Hong Kong Christian Service	Kowloon
Hong Kong	Yang Memorial Methodist Social Service Choi Hung Community Centre for Senior Citizens	Kowloon
Hong Kong	Jockey Club Centre for Positive Ageing	Sha Tin
Hong Kong	The Neighbourhood Advice- Action Council Ma On Shan Neighbourhood Elderly Centre	Sha Tin
Hong Kong	The Neighbourhood Advice-Action Council Sham Shui Po District Elderly Community Centre	Sham Shui Po
Hong Kong	The Neighbourhood Advice-Action Council Tuen Mun District Integrated Services Centre for the Elderly	Tuen Mun
Hong Kong	Yau On Lutheran Centre for the Elderly	Tuen Mun
Hong Kong	HKSKH Chuk Yuen Canon Martin District Elderly Community Centre	Wong Tai Sin
Hong Kong	Pentecostal Church of Hong Kong Ltd.Choi Wan Neighbourhood Elderly Centre	Wong Tai Sin

Sponsors (3)

Lead Sponsor	Collaborator
Hong Kong Metropolitan University	Chinese University of Hong Kong, Food and Health Bureau, Hong Kong

Country where clinical trial is conducted

Hong Kong, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Depression	The level of depression of PWEDs is measured by the 19-item Cornell Scale for Depression in Dementia (CSDD). It is to evaluate any adverse outcome posed by the intervention on them.	Baseline, immediately after the intervention, 1 month follow up
Other	Caregivers' stress	Caregivers' stress is measured by the 12-item Zarit Caregiver Burden Interview. It is to evaluate any adverse outcome posed by the intervention on family caregivers.	Baseline, immediately after the intervention, 1 month follow up
Primary	Change in advance care planning engagement	The behavior change process in ACP behaviours is measured using a 9-item ACP engagement survey. It covers two sub-scales, self-efficacy and readiness, of ACP engagement. Each item is rated on a 5-point likert scale. The higher score means the higher level of engagement for the ACP behaviour.	Baseline, immediately after the intervention, 1 month follow up
Secondary	Change in dyadic concordance of end-of-life care preferences	The dyadic concordance on end-of-life care preferences is measured by a modified Life Support Preferences Questionnaire (LSPQ). Dyads of participants are invited to answer individually, simultaneously but separately for a hypothetical scenario featured the prospect of developing into advanced stage of dementia. PWEDs are asked to indicate their preference for receiving three discrete life-sustaining medical treatments (cardio-pulmonary resuscitation, mechanical ventilation and tube feeding) using a 3 point Likert Scale (1=want to attempt; 2=refuse; 3= not sure). The dyadic congruence is determined based on whether both of them choose the same option for end-of-life treatments, regardless that was for active treatment or not, they gained a score of one. Given the nature of ACP is for the dyad to communicate preferences on end-of-life care, no score would be given if anyone in the dyad chose the "not sure" response.	Baseline, immediately after the intervention, 1 month follow up