None listed
Conditions
Brief summary
This project is the implementation and evaluation of a newly proposed model of service in the emergency department. The service comprises consultation with older patients (80 years and over) suffering from advanced frailty or chronic illness to make choices about their preferences and values so these can be incorporated in the treatment decisions. The evaluation will use a randomised trial design to compare the effectiveness of the new Goals of Care service with 'usual care' provided at Liverpool hospital before/during the intervention and with a control group in another teaching hospital (Westmead) where another model of service has been in place for several years. Mixed methods will include a qualitative investigation of the patient's and the implementers' satisfaction with the service. The aim of the study is to examine the feasibility, acceptability and effectiveness of the Goals of Care initiative in terms of type of care choices and place of death (institutional vs. community-based), as well as establishing concordance of wishes with actual care provided. It is hoped that the identification of the older people at high risk can be embedded in routine practice and the Goals of Care service will improve the uptake of advance care planning and reduce unnecessary hospitalisations.
Interventions
--Screening for frailty with Rockwood (CFS) instrument and screening for risk of death with CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) among patients aged 80+ years presenting at the participating hospital on 'intervention days'
--Guided Goals of Care conversation takes place face-to-face in the emergency department led by purpose-trained nurses who will also document patient values and preferences, and type of care which is coordinated by hospital. The 30-45
--Screening for frailty with Rockwood (CFS) instrument and screening for risk of death with CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) among patients aged 80+ years presenting at the participating hospital on 'intervention days' --Guided Goals of Care conversation takes place face-to-face in the emergency department led by purpose-trained nurses who will also document patient values and preferences, and type of care which is coordinated by hospital. The 30-45 minute Goals of care conversation is led by Clinical Nurse Consultants trained using the PREPARE materials and the End-of-Life Essential online modules. Patient preferences are elicited using a semi-structured guide and the final version in conventional bright yellow paper is placed in the patient's clinical notes. --Communication with admitting teams about patient preferences and goals of care occurs on the same day, either in the emergency department or on the ward, depending on where the conversation ends.
Sponsors
South Western Sydney Clinical School, UNSW
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
80 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Older people aged 80+ years presenting at emergency department and being admitted for at least one night and able to provide written consent to enable data linkage and follow-up telephone call at one and 3 months.
Exclusion criteria
-Unable to communicate in English unless an interpreter or relative available. -No surrogate present (in case of cognitive impairment or non-English speaking background) -CriSTAL score of less than 6
Outcome results
None listed