Intervention to Promote Advance Care Planning for Older Adults in the Emergency Department

Not Applicable

Completed

• Conditions: Advance Care Planning; Emergency Medicine
• Interventions: Behavioral: Educational Video; Behavioral: Primary Care Provider Email

• Registration Number: NCT03402763
• Lead Sponsor: University of North Carolina, Chapel Hill

Brief Summary

There is an urgent need to increase advance care planning among older adults in order to ensure that patients receive care of the end of life that is consistent with their values and preferences. Emergency departments (EDs) provide an opportunity to reach a large proportion of older adults who have not yet completed advance care planning at a time when they are likely to recognize the need for such planning. The purpose of this pilot is to examine the potential of a video-supported intervention initiated during the emergency department visit to promote advance care planning.

Detailed Description

The overarching goal of this project is to understand the impact of an ED-initiated intervention on the promotion of advance care planning (ACP) among older adults. Participants are given either a short informational handout on the process and choices involved in ACP or watch a 6-minute video about ACP. The video describes cardiopulmonary resuscitation (CPR), breathing tube placement, and mechanical breathing support in addition to the general process of ACP. Following the video, patients in the intervention will also have an email sent to their primary care provider. The email will inform the primary care provider that the patient has watched a video about ACP, include a brief synopsis of the video, and provide instructions as to how to document the patient's preferences in the hospital's electronic health record in a way that will be accessible to other providers. Outcomes will include documentation of end-of-life care preferences in the electronic health records and patient-reported conversation with their provider as well as conversations with loved ones.

Study Timeline

• Study Start: 2016-02-01
• Primary Completion: 2017-02-01
• Study Completion: 2017-02-01
• Status Verified: 2018-01
• Study First Submitted: 2018-01-10
• Study First Submitted QC: 2018-01-10
• Last Update Submitted: 2018-01-10
• Study First Posted: 2018-01-18
• Last Update Posted: 2018-01-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 42

Inclusion Criteria

• Ability to provide informed consent
• Ability to communicate in English
• Age 65-79 years with a serious medical illness: (1) Established diagnosis of metastatic cancer, advanced heart failure, chronic obstructive lung disease, end stage liver disease, end stage renal disease, (2) Unable to walk or requires human assistance with walking, (3) Two hospitalizations within the last 6 months
• Age 80 years or older

Exclusion Criteria

• Critically ill (emergency severity index = 1)
• Cognitively impaired based on Six Item Screener < 4 or lack the capacity to consent
• Currently enrolled in hospice or comfort care program
• No working phone number
• Non English speaker

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	Educational Video	Participants are shown a 6-minute video that describe CPR, breathing tube placement, and mechanical breathing support in addition to the general process of advance care planning.
Intervention	Primary Care Provider Email	Participants are shown a 6-minute video that describe CPR, breathing tube placement, and mechanical breathing support in addition to the general process of advance care planning.

Primary Outcome Measures

Name	Time	Method
Documentation of end-of-life preferences in the electronic health record	3 months	Since the ED visit, does the patient have any new preferences about CPR, intubation, or palliative care documented in their electronic health record?

Secondary Outcome Measures

Name	Time	Method
Conversation with Loved One	3 months	Patient-reported conversation with a trusted loved one (spouse, children, or sibling) about what they would want done if they became very sick, had serious breathing trouble, heart stopped, or they could not make medical decisions from him or herself.
Conversation with Regular Provider	3 months	Patient-reported conversation with their regular provider (primary care physician, admitting physician, other outpatient provider) about what they would want done if they became very sick, had serious breathing trouble, heart stopped, or they could not make medical decisions from him or herself.