A Cluster-randomized Trial Comparing Team-based Versus Primary Care Clinician-led Advance Care Planning in the Meta-LARC Practice-based Research Networks
试验速览
- 阶段
- 不适用
- 入组人数
- 1,120
- 试验地点
- 12
- 主要终点
- Global rating of goal-concordant care, patient-reported
研究概览
简要总结
This project compares two models of the Serious Illness Care Program (SICP) in primary care: clinician-focused SICP and team-based SICP. Discussion and planning for serious illness care can help patients identify what is most important to them and assure they receive care that best matches their goals and values, such as spending more time at home or not being in pain.
详细描述
Background and Significance:
Many people die after living with chronic conditions that have a broadly predictable course. This should give patients and families the opportunity to consider what is most important to them and plan for the care they wish to receive in their final months and at the end of life. However, in many cases health care defaults to more testing and treatments, creating a potential mismatch between healthcare services and what patients and families want.
Serious illness care planning occurs once a patient with advanced illness reaches a life expectancy of one to two years. Patients face a wide range of choices that can profoundly affect their quality of life. Planning for the last months and days may improve quality of life, by assuring health care supports patient goals and that preferences for life-sustaining interventions honored. For many patients, this planning should occur in the primary care setting, but primary care practices are over-extended, clinicians and staff are often uncomfortable discussing prognosis, and patients and families often do not ask.
The Serious Illness Care Program (SICP) provides a comprehensive implementation strategy, training modules, and a structured conversation guide to promote realistic and compassionate discussions with seriously ill patients in any health care setting. SICP is widely used, having trained hundreds of clinicians and used with thousands of patients. It contributes to the quadruple aims of optimizing healthcare performance through improving patient experience and appropriate utilization of resources, increasing population health, and improving the work life of clinicians. The challenge is that it is unclear whether whether targeting clinicians or entire teams is more efficient and effective when implementing SICP in primary care.
Study Aims:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Can provide verbal consent
- •Be an adult 18 years of age or older
- •Has a serious illness(es) or condition(s) that is likely to limit the patient's life expectancy to less than 2 years as defined by using clinical intuition or a patient identification algorithm when possible
- •Is community-dwelling or is planned to be discharged to a community-based setting
- •Can speak, read and write in English, French or Spanish
- •Has had an initial advance care planning (ACP) conversation at a primary care practice participating in this project.
排除标准
- •Patients may not already be enrolled in hospice
- •Patients may not currently be in an intensive care unit or hospital with no expectation of discharge
- •Patient may not be in an institution (e.g., nursing home) or awaiting nursing home placement in the near future
结局指标
主要结局
Global rating of goal-concordant care, patient-reported
时间窗: 12 months after enrollment
Comparison between arms of whether care received corresponds to patient goals. This will be assessed at 12 months.
次要结局
- Cumulative time spent at home, patient-reported questionnaires(12 months after enrollment)
- Generalized Anxiety Disorder (GAD-7)(Baseline, 6 months and 12 months after enrollment)
- Patient Health Questionnaire (PHQ-9) - Depression(Baseline, 6 months and 12 months after enrollment)
- Patient-reported outcomes for individuals living with chronic conditions(Baseline, 6 months and 12 months after enrollment)
- SICP acceptability(Baseline, 6 months and 12 months after enrollment)
- SICP experience(Baseline, 6 months and 12 months after enrollment)
- Quality of communication(Baseline, 6 months and 12 months after enrollment)
- Shared decision making for healthcare decisions(Baseline, 6 months and 12 months after enrollment)
- Hospice use(Baseline, 6 months and 12 months after enrollment)
- Detailed items on goal-concordant care(6 months and 12 months after enrollment)
- Global rating of goal-concordant care, patient-reported(6 months after enrollment)
研究者
Annette Totten
Associate Professor
Oregon Health and Science University