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Advance Care Planning & Goals of Care Randomized Controlled Trial in Primary Care

2018-02-21 19:15:13 | 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 for people to think about their 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. In Alberta there is a form in the health care system that is used to indicate a person's wishes if participants are unable to speak for themselves. It is best to fill out the Goal of Care Designation form after a person has thought about what is most important to them and when they understand some of the possible decisions. There are tools such as brochures, questionnaires, and videos that can help participants learn about these things. This research is being done to study whether using tools for advance care planning and goals of care discussions will increase the number of patients that have their wishes documented in their medical record. The research is also being done to study whether the tools help patients understand what is most important to them and help them make the best decisions. This study is evaluating whether patients who meet with an advance care planning navigator to learn about advance care planning and use a decision aid are more likely to complete a goals of care form than patients who receive usual care.

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. The aim of this study is 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 presence of a goals of care form in the chart, substitute decision-maker engagement in ACP (including self-efficacy for enacting the role), patient engagement in ACP, and decisional conflict.

Study Design

Conditions

Chronic Illness

Intervention

ACP Education, Usual care

Location

Family Medical Centre
Lethbridge
Alberta
Canada
T1K 3M5

Status

Recruiting

Source

McMaster University

Results (where available)

View Results

Links

Published on BioPortfolio: 2018-02-21T19:15:13-0500

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