Improving Advance Care Planning by Preparing Diverse Seniors for Decision Making
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Chronic Disease
- Sponsor
- University of California, San Francisco
- Enrollment
- 541
- Locations
- 1
- Primary Endpoint
- New advance care planning documentation in the medical record
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
The objective of this proposal is to test whether a multi-media website (www.prepareforyourcare.org) that is focused on preparing older adults for communication and medical decision making can help people engage in advance care planning.
Detailed Description
PREPARE is a website (www.prepareforyourcare.org) that teaches patients how to identify what is most important in life, how to communicate their preferences to clinicians and loved ones, and how to make informed decisions. It is written at a 5th grade level and includes voice-overs of text and closed captioning of videos that model advance care planning behaviors. The goal of this proposal is to test the efficacy of PREPARE plus an easy-to-read advance directive, versus an advance directive alone, to improve patient engagement in multiple advance care planning behaviors including discussions with surrogate decision makers and clinicians in addition to advance directive completion. The investigators will also determine whether PREPARE can empower and activate patients within clinical encounters with their clinicians and help to decrease health disparities in advance care planning.
Investigators
Eligibility Criteria
Inclusion Criteria
- •English-speaking older adults (≥55 years)
- •≥ 2 chronic illnesses determined by International Classification of Diseases-9 (ICD-9) codes
- •≥ 2 visits with an outpatient primary care clinician at San Francisco General Hospital in the past year
- •≥2 additional outpatient/inpatient visits to San Francisco General Hospital in the past year
Exclusion Criteria
- •deaf, blind, or demented as determined by ICD-9 codes
- •too mentally or physically ill to participate as determined by their clinicians
- •Moderate or severe cognitive impairment as determined by the Short Portable Mental Status Questionnaire (SPMSQ), and mild cognitive impairment as determined by the SPMSQ plus an abnormal Mini-Cog
- •self-reported poor vision and inability to see the words on a newspaper
- •lack of a telephone
- •traveling or moving out of the area for ≥3 months during the study follow- up period
Outcomes
Primary Outcomes
New advance care planning documentation in the medical record
Time Frame: 15 months after study enrollment
The primary outcome is documentation of ACP wishes in the medical record. ACP documentation for the purposes of this study includes legal advance directive forms or other documentation of patients wishes for medical care in clinical notes.
Secondary Outcomes
- Self-reported engagement in advance care planning behaviors(12 months from baseline)