ENgaging in Advance Care Planning Talks Group Visit Intervention

Not Applicable

Completed

Conditions: Primary Health Care
Advance Care Planning

Interventions: Behavioral: Mailed Resources
Behavioral: ENACT group visit

Registration Number: NCT03141242

Lead Sponsor: University of Colorado, Denver

Brief Summary: The main goal of the ENACT (ENgaging in Advance Care planning Talks) Group Visit intervention is to integrate a patient-centered advance care planning process into primary care, ultimately helping patients to receive medical care that is aligned with their values. The ENACT Group Visit intervention involves two group discussions about advance care planning with 8-10 patients who meet for 2-hour sessions, one month apart, facilitated by a geriatrician and a social worker. This study will compare the ENACT Group Visit intervention to mailed advance care planning materials.

Detailed Description: This pilot feasibility randomized controlled study will determine the feasibility, acceptability and preliminary efficacy of the ENACT Group Visit intervention compared to a comparison arm.

The ENACT Group Visit intervention aims to engage patients in an interactive discussion of key ACP concepts and support patient-initiated ACP actions (i.e. choosing decision-maker(s), deciding on preferences during serious illness, discussing preferences with decision-makers and healthcare providers, and documenting advance directives). The group visits involve two 2-hour sessions, one month apart, facilitated by a geriatrician and a social worker. The ENACT Group Visit is based on an intervention manual that guides the structure, facilitator considerations, session format, and documentation and billing details. The discussions include sharing experiences related to ACP, considering values related to serious illness, choosing a surrogate decision-maker(s), flexibility in decision making, and having conversations with decision-makers and healthcare providers. The facilitators support an interactive discussion that promotes opportunities for patients to learn from others' experiences.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 110

Inclusion Criteria

50 or older
Receive primary care through UCHealth, Colorado, USA.

Exclusion Criteria

Severe cognitive impairment, known diagnoses of dementia
Severe hearing loss or deafness

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Mailed Resources	Mailed Resources	Participants will receive printed advance care planning resources by mail.
ENACT Group Visit	ENACT group visit	Participants will engage in two 2-hour group visits related to advance care planning, including printed advance care planning resources.

Primary Outcome Measures

Name	Time	Method
Presence of Medical Decision-maker Documentation in the EHR	0, 6 months	An MDPOA form is in electronic medical chart or an orally appointed decision maker
Presence of Advance Directive in the EHR	0 and 6 months	Presence of any advance directive document in the EHR (e.g., MDPOA, living will, Colorado MOST form)

Secondary Outcome Measures

Name	Time	Method
Change in Readiness to Engage in ACP (ACP Engagement Score)	0, 6 months	The Advance Care Planning (ACP) Engagement Scale will be used to assess readiness to engage in specific parts of the advance care planning process (i.e. signing official papers to name a medical decision maker; talking to the decision maker; talking to the doctor; signing official papers putting their wishes in writing). Items are rated on a Likert scale, with possible scores ranging from 1-5. Higher scores indicate a higher level of engagement with the advance care planning behavior and a better outcome.
Change in Readiness to Discuss Values and Care Preferences With Surrogate Decision Maker	0, 6 months	Patient response to the question "How ready are you to talk with your decision maker about what kind of medical care you would want if you were very sick or near the end of life?". Responses were rated on a Likert scale, with possible scores ranging from 1-5. Higher scores indicate more readiness and a better outcome."
Change in Readiness to Chose a Surrogate Decision Maker	0, 6 months	Patient response to the question "How ready are you to sign official papers naming a medical decision maker to make medical decisions for you?". Responses were rated on a Likert scale, with possible scores ranging from 1-5. Higher scores indicate more readiness and a better outcome.
Readiness to Sign Official Papers About Medical Care	0 and 6 months	Patient response to the question "How ready are you to sign official papers putting your wishes in writing about the kind of medical care you would want if you were very sick or near the end of life?". Responses were rated on a Likert scale, with possible scores ranging from 1-5. Higher scores indicate more readiness and a better outcome.
Readiness to Talk to Patient's Physician About Future Medical Care	0 and 6 months	Patient response to the question "How ready are you to talk to your doctor about the kind of medical care you would want if you were very sick or near the end of life?". Responses were rated on a Likert scale, with possible scores ranging from 1-5. Higher scores indicate more readiness and a better outcome.
Change in Advance Directive in Medical Record	0, 3, 6, 12 months	Any advance directive is present in the medical chart