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RCT of Advance Care Planning in Primary Care

2017-08-06 14:36:19 | BioPortfolio

Summary

Sometimes people with health conditions become ill suddenly and can no longer speak for themselves and another person (such as a family member) will make health care decisions for them. This means it is important to think about your wishes and tell others about them. This is called advance care planning. When people have done advance care planning, if they become very sick and cannot speak for themselves they are more likely to get the kind of health care they want and it is easier for the people who make decisions for them. There are tools such as brochures, questionnaires, and videos that can help people learn about these things. This research is being to done to study whether using tools for advance care planning and goals of care discussions will improve how patients and their substitute decision makers do advance care planning. This study is a randomized trial. This means half of the people in this study will meet with someone at their family practice to talk about advance care planning and review some tools and half will get usual care (a pamphlet). The study will 1) evaluate if reviewing the tools, and having help to complete them, helps patients and their substitute decision maker do advance care planning 2) if this intervention will encourage patients to talk to their family doctor about these issues.

Description

In prospective and randomized trials, advance care planning (ACP) significantly improves outcomes including increased likelihood that clinicians and families understand and comply with a patient's wishes, reduces hospitalization at the end of life, results in less intensive treatments at the end of life (according to patients' wishes) and increases use of hospice services. Trials have not been done in primary care. In this project, we aim to determine the efficacy of a care pathway designed to increase the quality and quantity of ACP in patients and their substitute decision-makers in primary care. The study is a multi-site, patient-based, unblinded, randomized trial conducted in family practices in Canada. Participants will be patients who are determined by their physician to be able to benefit from ACP, and the patient's substitute decision-maker. Participant pairs will be randomized to immediate intervention (care pathway) or delayed (8-12 weeks). The intervention is guided use of tools and decision aids to clarify values and preferences for treatments in the event of serious illness or near end of life. The outcomes will be substitute decision-maker engagement in ACP (including self-efficacy for enacting the role), patient engagement in ACP, and decisional conflict.

Study Design

Conditions

Serious Illness

Intervention

Advance care planning education session, Wait list control

Location

Department of Family Medicine
Hamilton
Ontario
Canada
L8P 1H9

Status

Not yet recruiting

Source

McMaster University

Results (where available)

View Results

Links

Published on BioPortfolio: 2017-08-06T14:36:19-0400

Clinical Trials [3376 Associated Clinical Trials listed on BioPortfolio]

Advance Care Planning in Cognitive Disorders Clinic

Advance care planning among patients with cognitive disorders poses unique challenges to clinicians. To improve planning in patients with Alzheimer's disease and other dementias, the resea...

Utilizing Advance Care Planning Videos to Empower Perioperative Cancer Patients and Families

Through close engagement with our patient and family member co-investigators, we have developed a video-based advance care planning aid for cancer patients and their family members who are...

Patient Perception of Video Advance Care Planning

Rates of advance directive completion among Americans, even those suffering from serious chronic illness, are notoriously poor. Moreover, the contents of completed advance directives are o...

Reducing Disparities in the Quality of Advance Care Planning for Older Adults

This study compares the effectiveness of two different approaches to advance care planning among older African Americans and older Whites living in the community. The two approaches are a ...

Advance Care Planning Coaching for Patients With Chronic Kidney Disease

This project will develop and test a model intervention for Advance Care Planning (ACP) for patients with advanced chronic kidney disease (CKD) cared for in nephrology clinics that have th...

PubMed Articles [22245 Associated PubMed Articles listed on BioPortfolio]

A Collaborative educational intervention to improve pre-clinical medical student confidence with Advance Care Planning (ACP).

Advance care planning (ACP) is an essential skill for clinicians, yet trainees feel inadequately prepared to conduct ACP discussions. Optimal teaching methods and timing are unknown.

Advance care planning: what do patients want?

Advance care planning is the process by which patients can make decisions about their future health care should they lose capacity. Such conversations are shown to improve quality of life and reduce i...

Integrating Advance Care Planning Videos into Surgical Oncologic Care: A Randomized Clinical Trial.

Preoperative advance care planning (ACP) may benefit patients undergoing major surgery.

Primary care clinicians' confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey.

People who engage in advance care planning (ACP) are more likely to receive health care that is concordant with their goals at the end of life. Little discussion of ACP occurs in primary care.

Concordance between self-reported completion of advance care planning documentation and availability of documentation in Australian health and residential aged care services.

Advance care planning (ACP) documentation needs to be available at the point of care to guide and inform medical treatment decision-making.

Medical and Biotech [MESH] Definitions

Discussions with patients and/or their representatives about the goals and desired direction of the patient's care, particularly end-of-life care, in the event that the patient is or becomes incompetent to make decisions.

A food service control process involving scheduling of meals in advance.

Declarations by patients, made in advance of a situation in which they may be incompetent to decide about their own care, stating their treatment preferences or authorizing a third party to make decisions for them. (Bioethics Thesaurus)

The purpose of this 1990 federal act is to assure that individuals receiving health care services will be given an opportunity to participate in and direct health care decisions affecting themselves. Under this act, hospitals, health care agencies, and health maintenance organizations are responsible for developing patient information for distribution. The information must include patients' rights, advance directives, living wills, ethics committees' consultation and education functions, limited medical treatment (support/comfort care only), mental health treatment, resuscitation, restraints, surrogate decision making and transfer of care. (from JCAHO, Lexicon, 1994)

Health care programs or services designed to assist individuals in the planning of family size. Various methods of CONTRACEPTION can be used to control the number and timing of childbirths.

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