Me & My Wishes: An Efficacy Trial Using Videos

Not Applicable

Completed

Brief Summary: The aim of this study is to determine whether the Me \& My Wishes intervention positively impacts communication of preferences among nursing home residents with dementia and their family caregivers and care team.

Detailed Description: Me \& My Wishes are videos of nursing home residents talking about their preferences for care, including four sections: About Me, Preferences for Today, Preferences for Medical Intervention and End of Life, and Afterthoughts. Knowing what residents want is essential to staff's ability to provide quality care and can inform family caregivers decision making especially in later stages of life as the resident's cognition declines-a time when family caregivers often feel unprepared. Persons with mild to moderate dementia can accurately express their everyday and EOL preferences, however, stereotypes persist about the decision making abilities of people with dementia that often prevent their involvement in conversations about care. The investigators propose to conduct a Stage II efficacy trial of Me \& My Wishes-a novel approach for communicating resident care preferences-by creating videos with 48-54 nursing home residents with mild to moderate dementia and sharing their personalized video with informal (family) and formal (staff) caregivers. The investigators will employ a randomized wait-list control design in which residents in control nursing homes will delay sharing their video. Videos may be viewed two ways: 1) in resident quarterly care conferences; and 2) via a web-based link with resident-identified family members or friends.

Recruitment & Eligibility

Inclusion Criteria

Identified as having Alzheimer's or related dementia
Mild to moderate cognitive impairment (BIMS = 8-15, (MDS C0500) (nursing home residents only)
Makes Self Understood = <1 (MDS B0700)/present in medical record
Understood By Others = <1 (MDS B0800)/present in medical record
Reside at the facility at least 2 weeks identified as a long-term resident
Age >65 years
Speaks English

Family Inclusion Criteria:

Speaks English
Willing and able to watch the videos
Willing to complete short surveys. Being unable to attend care conference to view the video (e.g. due to distance) will not exclude family from participating.

Staff Inclusion Criteria:

Resident

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Me & My Wishes Intervention/Group 1	Me & My Wishes	In Group 1 (early intervention group) NHs, video recording, editing, and viewing will occur within three months of baseline.
Me & My Wishes Wait-list control/Group 2	Me & My Wishes	In Group 2 (delayed sharing) NHs, residents will be on a wait-list; after the delayed start, their video will be produced and viewed within three months.

Primary Outcome Measures

Name	Time	Method
Number of Participants With a Documented Discussion of Goals of Care	Baseline, time of sharing (3 months from baseline), and 90 days post sharing video	At each specified time point, a chart review was conducted to obtain whether goals of care discussions occurred (change in documentation in medical record, e.g. social work note), yes/no. Reported values indicated residents who had a documented GOC in chart (yes) at any time point. Goal of Care Conversations encompass two parts. A) some sharing of disease status / prognosis + B) discussion of a choice of goals/treatment decisions. Examples of Part A include disease understanding, disease state, disease progression, prognosis/life expectancy, documentation that the clinician tried to discuss prognosis but the patient/family refused

Secondary Outcome Measures

Name	Time	Method
Self-efficacy for Communicating Preferences	Baseline, time of sharing (3 months from baseline), and 90 days post sharing video	Confidence in expressing or communicating about resident preferences. Self-efficacy items, range 1-5, higher is more confident.

Locations (8): Marquis Wilsonville Assisted Living
🇺🇸
Wilsonville, Oregon, United States
Marquis Hope Village Assisted Living
🇺🇸
Canby, Oregon, United States
Marquis Forest Grove Assisted Living
🇺🇸
Forest Grove, Oregon, United States
Marquis Forest Grove Post Acute Rehab
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Forest Grove, Oregon, United States
Regency Gresham Nursing and Rehabilitation Center
🇺🇸
Gresham, Oregon, United States
Marquis Wilsonville Post Acute Rehab
🇺🇸
Wilsonville, Oregon, United States
French Prairie Nursing and Rehab
🇺🇸
Woodburn, Oregon, United States
Woodland Care Center
🇺🇸
Woodland, Washington, United States