Randomized Control Trial of Advance Care Planning in Primary Care

Not Applicable

Completed

Interventions: Other: Wait list control
Behavioral: Advance care planning education session

Brief Summary: Sometimes people with health conditions become ill suddenly and can no longer speak for themselves and another person (such as a family member) will make health care decisions for them. This means it is important to think about your wishes and tell others about them. This is called advance care planning. When people have done advance care planning, if they become very sick and cannot speak for themselves they are more likely to get the kind of health care they want and it is easier for the people who make decisions for them. There are tools such as brochures, questionnaires, and videos that can help people learn about these things. This research is being to done to study whether using tools for advance care planning and goals of care discussions will improve how patients and their substitute decision makers do advance care planning. This study is a randomized trial. This means half of the people in this study will meet with someone at their family practice to talk about advance care planning and review some tools and half will get usual care (a Speak Up workbook). The study will 1) evaluate if reviewing the tools, and having help to complete them, helps patients and their substitute decision maker do advance care planning 2) if this intervention will encourage patients to talk to their family doctor about these issues.

Detailed Description: In prospective and randomized trials, advance care planning (ACP) significantly improves outcomes including increased likelihood that clinicians and families understand and comply with a patient's wishes, reduces hospitalization at the end of life, results in less intensive treatments at the end of life (according to patients' wishes) and increases use of hospice services. Trials have not been done in primary care. In this project, we aim to determine the efficacy of a care pathway designed to increase the quality and quantity of ACP in patients and their substitute decision-makers in primary care. The study is a multi-site, patient-based, unblinded, randomized trial conducted in family practices in Canada. Participants will be patients who are determined by their physician to be able to benefit from ACP, and the patient's substitute decision-maker. Participant pairs will be randomized to immediate intervention (care pathway) or delayed (8-12 weeks). The intervention is guided use of tools and decision aids to clarify values and preferences for treatments in the event of serious illness or near end of life. The outcomes will be substitute decision-maker engagement in ACP (including self-efficacy for enacting the role), patient engagement in ACP, and decisional conflict.

Recruitment & Eligibility

Inclusion Criteria

Patients being treated for serious illness in outpatient settings or;
Patients who could benefit from advance care planning self-assessed or assessed by their physician
Patient able and willing to identify a substitute decision-maker who will participate in the study
Patient cognitively able to participate

Exclusion Criteria

Patient or their substitute decision-maker does not speak English
Patient unable to identify a substitute decision-maker who will consent to participation
Patient does not consent to participation

Arm && Interventions

Group	Intervention	Description
Wait list control	Wait list control	The intervention is not provided.
Advance care planning education session	Advance care planning education session	Delivery of an advance care planning education session at the family doctor's office

Primary Outcome Measures

Name	Time	Method
Advance care planning engagement of substitute decision-maker	8 to 12 weeks (6 weeks for patients from cancer centre)	A survey of the substitute decision-maker's engagement in advance care planning

Secondary Outcome Measures

Name	Time	Method
Advance care planning engagement of patient	8 to 12 weeks (6 weeks for patients from cancer centre)	A survey of the patient's engagement in advance care planning
Substitute decision-maker self-efficacy survey	8 to 12 weeks (6 weeks for patients from cancer centre)	A survey of the substitute decision-maker's confidence to make future decisions
Satisfaction with intervention	immediately after intervention	A satisfaction and endorsement survey on the process of the educational intervention
Decisional conflict	immediately after intervention	A modified short decisional conflict survey

Locations (7): Burlington Family Health Team
🇨🇦
Hamilton, Ontario, Canada
McMaster University Medical Centre
🇨🇦
Hamilton, Ontario, Canada
Michael West Doctor Office
🇨🇦
Dundas, Ontario, Canada
Dundas Family Health Team
🇨🇦
Dundas, Ontario, Canada
McMaster Family Health Team
🇨🇦
Hamilton, Ontario, Canada
Juravinski Cancer Centre Pain and Symptom Management Team
🇨🇦
Hamilton, Ontario, Canada
St. Joseph's Healthcare Hamilton
🇨🇦
Hamilton, Ontario, Canada