Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly
- Conditions
- Other Cancer
- Interventions
- Other: Clinician Communication Skills TrainingOther: Advance Care Planning (ACP) Decisions Videos Decisions AidsOther: Video Declarations (ViDec)
- Registration Number
- NCT03609177
- Lead Sponsor
- Dana-Farber Cancer Institute
- Brief Summary
In this research study, the investigators are working to help oncologists better serve patients by delivering more patient-centered, goal-concordant care that may improve health care delivery.
- It is expected that about 30,000 people will take part in this research study, 29,550 of these patients, the vast majority, will be included only for medical record review.
- Detailed Description
The purpose of this study is to improve the quality of care provided to millions of older Americans with cancer. The investigators are working to help oncologists better serve patients by delivering more patient-centered, goal-concordant care that may dramatically improve health care delivery.
This is pragmatic stepped wedge cluster randomized trial (SW-CRT) of a Comprehensive ACP (Advance Care Planning) Program among older oncology patients. The ACP Program will include training clinicians in communication skills and using video decision aids for participants.
- This study will involve medical record review of 30,000 people age 65 or older with advanced cancer.
We will also recruit 450 eligible patients (150 patients from each of our three sites broken down into 75 patients during the control phase and 75 patients during the intervention phase) to conduct a survey for our secondary patient-centered outcomes (confidence, satisfaction with physician communication, patient decisional satisfaction and regret). From among this sub-group we will engage 240 participants (80 from each of our three sites broken down into 40 patients during the control phase and 40 patients during the intervention phase) in an activity to film video declarations of their preferences.
During the first year, three pilot sites (one at each health care system) will trial the intervention. The subjects recruited at these pilot sites will not be included in the final analysis. Thus, the main trial will begin during year 2 and continue through year 5 with recruitment of 30,000 subjects for the primary outcome at 30 oncology clinics. The first year pilot will serve to inform the larger roll-out and the intervention may change during the first year based on pilot-clinic experience.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 27446
Not provided
- Adults unable to consent
- Individuals who are not yet adults (infants, children, teenagers)
- Pregnant women
- Prisoners
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Advance Care Planning Clinician Communication Skills Training -Survey: * A group of older patients with advanced cancer (N=450) will have a survey over the course of the 36 months of recruitment. * Participants will be provided written copies of the questions to follow along during the interviews Comprehensive Record Review of ACP Advance Care Planning (ACP) Decisions Videos Decisions Aids * A review of Medical orders for resuscitation preferences in the electronic health record * A review of Medical orders for Palliative care consultations preferences in the electronic health record * A review of Medical orders for Hospice use preferences in the electronic health record Main Study Arm Clinician Communication Skills Training Patients with cancer being seen at the 30 oncology clinics will be exposed to clinicians who have had communication skills training (Vital Talk) and who are using video decision aids (ACP Decisions). Our main outcome is advance care planning documentation. Advance Care Planning Advance Care Planning (ACP) Decisions Videos Decisions Aids -Survey: * A group of older patients with advanced cancer (N=450) will have a survey over the course of the 36 months of recruitment. * Participants will be provided written copies of the questions to follow along during the interviews Advance Care Planning-Video Declaration Clinician Communication Skills Training Video Declaration: * From among this group of 450 participants, the video declaration of preferences activity will be conducted with 240 patients. * For those participants that agree to the video declaration, they will proceed with recording of their video declarations * The RA will begin by reading a standardized introduction to aid the subject do the video Comprehensive Record Review of ACP Clinician Communication Skills Training * A review of Medical orders for resuscitation preferences in the electronic health record * A review of Medical orders for Palliative care consultations preferences in the electronic health record * A review of Medical orders for Hospice use preferences in the electronic health record Main Study Arm Video Declarations (ViDec) Patients with cancer being seen at the 30 oncology clinics will be exposed to clinicians who have had communication skills training (Vital Talk) and who are using video decision aids (ACP Decisions). Our main outcome is advance care planning documentation. Advance Care Planning-Video Declaration Advance Care Planning (ACP) Decisions Videos Decisions Aids Video Declaration: * From among this group of 450 participants, the video declaration of preferences activity will be conducted with 240 patients. * For those participants that agree to the video declaration, they will proceed with recording of their video declarations * The RA will begin by reading a standardized introduction to aid the subject do the video Comprehensive Record Review of ACP Video Declarations (ViDec) * A review of Medical orders for resuscitation preferences in the electronic health record * A review of Medical orders for Palliative care consultations preferences in the electronic health record * A review of Medical orders for Hospice use preferences in the electronic health record Advance Care Planning-Video Declaration Video Declarations (ViDec) Video Declaration: * From among this group of 450 participants, the video declaration of preferences activity will be conducted with 240 patients. * For those participants that agree to the video declaration, they will proceed with recording of their video declarations * The RA will begin by reading a standardized introduction to aid the subject do the video Main Study Arm Advance Care Planning (ACP) Decisions Videos Decisions Aids Patients with cancer being seen at the 30 oncology clinics will be exposed to clinicians who have had communication skills training (Vital Talk) and who are using video decision aids (ACP Decisions). Our main outcome is advance care planning documentation.
- Primary Outcome Measures
Name Time Method Advance Care Planning Documentation 4 years Any advance directive (e.g., living will, POLST, etc.) and changes of resuscitation orders or any indication in the EHR of a goals-of-care or advance care planning conversation
- Secondary Outcome Measures
Name Time Method Rate of Preferences for Resuscitation 4 years Documented choices regarding CPR and mechanical ventilation in the EHR
Communication and Decisional Satisfaction 4 years (In person survey) patient satisfaction with communication and decision making
Rate of Hospice Use 4 years Use of hospice documented in the EHR
Rate of Palliative Care Consultation 4 years Use of palliative care services (consults, outpatient visits) in the EHR
Confidence in Future Care 4 years (in person survey) patient confidence that they will receive the right care at the right time by their health system
Decisional Regret 4 years (In person survey) patient regret regarding decision making
Trial Locations
- Locations (4)
Dana Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Duke Health
🇺🇸Durham, North Carolina, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Northwell Health
🇺🇸New Hyde Park, New York, United States