Improving Advance Care Planning by Preparing Diverse Seniors for Decision Making
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 541
- 试验地点
- 2
- 主要终点
- New advance care planning documentation in the medical record
研究概览
简要总结
The objective of this proposal is to test whether a multi-media website (www.prepareforyourcare.org) that is focused on preparing older adults for communication and medical decision making can help people engage in advance care planning.
详细描述
PREPARE is a website (www.prepareforyourcare.org) that teaches patients how to identify what is most important in life, how to communicate their preferences to clinicians and loved ones, and how to make informed decisions. It is written at a 5th grade level and includes voice-overs of text and closed captioning of videos that model advance care planning behaviors. The goal of this proposal is to test the efficacy of PREPARE plus an easy-to-read advance directive, versus an advance directive alone, to improve patient engagement in multiple advance care planning behaviors including discussions with surrogate decision makers and clinicians in addition to advance directive completion. The investigators will also determine whether PREPARE can empower and activate patients within clinical encounters with their clinicians and help to decrease health disparities in advance care planning.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- Double (Participant, Investigator)
入排标准
- 年龄范围
- 55 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •English-speaking older adults (≥55 years)
- •≥ 2 chronic illnesses determined by International Classification of Diseases-9 (ICD-9) codes
- •≥ 2 visits with an outpatient primary care clinician at San Francisco General Hospital in the past year
- •≥2 additional outpatient/inpatient visits to San Francisco General Hospital in the past year
排除标准
- •deaf, blind, or demented as determined by ICD-9 codes
- •too mentally or physically ill to participate as determined by their clinicians
- •Moderate or severe cognitive impairment as determined by the Short Portable Mental Status Questionnaire (SPMSQ), and mild cognitive impairment as determined by the SPMSQ plus an abnormal Mini-Cog
- •self-reported poor vision and inability to see the words on a newspaper
- •lack of a telephone
- •traveling or moving out of the area for ≥3 months during the study follow- up period
研究组 & 干预措施
PREPARE intervention
The PREPARE arm will review the PREPARE website plus the easy-to-read advance directive (AD). Participants will review PREPARE on their own for ≥ 20 minutes with staff present to answer questions. During PREPARE, participants answer preference questions and make an action plan (i.e., commitment to engage in advance care planning). To ensure home access to PREPARE content, participants will be given a website login and PREPARE content in digital video disc (DVD), booklet, and pamphlet format as well as the action plan and AD. One to three days before a primary care visit, the PREPARE arm will receive a reminder to come to their appointment and to bring their action plan.
干预措施: PREPARE Intervention (Behavioral)
Control
The Control arm will review an easy-to-read AD. Controls will review the AD for ≥ 15 minutes with study staff present to answer questions and will take the AD home to complete if desired. One to three days before a primary care visit, controls will receive a reminder to come to their appointment.
结局指标
主要结局
New advance care planning documentation in the medical record
时间窗: 15 months after study enrollment
The primary outcome is documentation of ACP wishes in the medical record. ACP documentation for the purposes of this study includes legal advance directive forms or other documentation of patients wishes for medical care in clinical notes.
次要结局
- Self-reported engagement in advance care planning behaviors(12 months from baseline)