Comparison of a Web-based Advance Directive to a Standard Advance Directive

Not Applicable

Completed

Interventions: Other: Standard advance directive
Other: Web platform for advance care planning/advance directive

Brief Summary: This study will compare a web-based advance directive to a standard advance directive.

Detailed Description: Patients with GI and thoracic malignancies will be randomized to either a standard paper advance directive or the web advance directive (Ourcarewishes.org). Patients will be approached in the Cancer Center and provided the AD information to complete on their own. They will complete a survey at enrollment and a follow up survey administered by email. The primary endpoint will be proportion with new documentation in the EHR at 8 weeks. Second endpoints will include the change in satisfaction with end-of-life plans, AD acceptability, self-reported rates of completion, self-reported rate of sharing with their preferred surrogate decision-maker, proportion with new documentation of preferred decision-maker in the chart, and qualitative feedback. Patients in both groups will receive follow up reminder emails encouraging them to complete the advance directive.

Recruitment & Eligibility

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Arm && Interventions

Group	Intervention	Description
Paper AD	Standard advance directive	Patients will be given the standard advance directive and encouraged to complete on their own.
Web-based AD	Web platform for advance care planning/advance directive	Patients will be encouraged to use the web platform for advance care planning/advance directive to document their care preferences..

Primary Outcome Measures

Name	Time	Method
New documentation of advance care planning in the EHR	8 weeks	any new advance directive or advance care planning note, excluding an advance directive that either 1) contains only information on the patient's preferred surrogate decision-makers, or 2) is blank except for personal identifying information.

Secondary Outcome Measures

Name	Time	Method
Self reporting sharing with surrogate	Survey sent at 15 days (reminders 4, 6)Survey sent at 15 days (reminders at 2 week intervals x 2, then phone call)	Proportion reporting sharing with preferred surrogate
Self reporting completion	Survey sent at 15 days (reminders at 2 week intervals x 2, then phone call)	Proportion reporting completing some or all of the advance directive
Qualitative feedback	Survey sent at 15 days (reminders at 2 week intervals x 2, then phone call)	Comments on what patients liked, did not like, and would change about the advance directive
Change in satisfaction with end-of-life plans	Initial completed at enrollment, survey sent again at 15 days	Change in mean score on the satisfaction with end-of-life scale, adapted from doi: 10.1377/hlthaff.2012.0895, Canadian Healthcare Evaluation Project (CANHELP) questionnaire. This scale measures satisfaction with end-of-life planning on a 12-60 point scale (if all questions answered, 0 possible if "don't know/refusal" chosen for all 12 questions. Higher scores are considered better.
Acceptability	Survey sent at 15 days (reminders at 2 week intervals x 2, then phone call)	Mean score on an acceptability scale adapted from DOI: 10.1016/j.pec.2007.08.015. This is a scale that measures advance directive acceptability on a 5-50 point scale. Higher scores represent better outcomes.
Surrogate preferences	8 weeks	Proportion of subjects with new information about their preferred surrogate decision-maker in the chart

Locations (1): Ruth & Raymond Perelman Center for Advanced Medicine
🇺🇸
Philadelphia, Pennsylvania, United States

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