Shared decision making regarding life support care Not Applicable Shared decision making regarding life support care
Conditions
Interventions
This evaluation randomly assigns 48 specialty care clinics from 12 facilities to receive either:
1. High intensity communication skills training for both physicians who can write life
or
2. Low-intensity training for physicians and non-physicians (Low Ed-All)
or
3. High intensity training for physicians, and low intensity training for non-physicians (High Ed-MD).
We will assign two clinics at each facility to Low Ed-All, on
preparing patients for life sustaining treatment discussions
and using team-based strategies to incorporate life sustaining treatment discussions into practice. High Ed training sessions will be administered using a train-the-trainer model, whereby each facilit
Sponsors
Veterans Affairs National Center for Ethics in Health Care
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Facilities. 1. Veterans Health Administration medical center with complexity level 1a or 1b 2. Have not yet trained specialty care staff in the interventions evaluated Clinics: 1. Cardiology, nephrology, oncology and pulmonology clinics agreed to participate in the evaluation. Staff. 1. Physicians, physician assistants, advance practice registered nurses, and fellows in one of the participating clinics Patients: 1. Life sustaining treatment decision documented by staff in one of the participating clinics after the completion of the clinic training period. 2. Life sustaining treatment decision consented by patient 3. Age 18 or older
Exclusion criteria
Exclusion criteria: Patients: 1. Deceased 2. Enrolled in hospice 3. Life sustaining treatment decision consented by surrogate 4. Recently recruited to one of the Veterans Health Administration’s patient satisfaction surveys
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Life sustaining treatment decision documentation completion will be measured using information on the number of items completed within the 4 fields of a life sustaining treatment progress note template, stored in administrative data over the six months following the clinic training period. We will define documentation completion as presence of a completed progress note in the administrative records. A life sustaining treatment progress note cannot be completed unless the following four fields of the template are filled in: (1) decision making capacity (yes, no), (2) patient reported goals of care (cure, prolonged life, function / independence / quality of life, comfort, obtain caregiving/family support, achieve life goals), (3) code status (full code, do not resuscitate / do not resuscitate except in situations specified), and (4) who provided informed consent (patient, surrogate, other). 2. Life sustaining treatment decision documentation comprehensiveness will be measured using the number of items (out of a total of 8) completed in the life sustaining treatment progress note (total number completed as 1 measure and categorization - none, minimal number completed, more than minimum completed as another measure) over the 6 months following the clinic training period 3. Life sustaining treatment decision documentation timing will be measured using the date of the first visit to an eligible specialty care clinic by an eligible patient and the date of life sustaining treatment progress note completion over the 6 months following the clinic training period 4. Patient-reported quality of provider communication will be measured using a previously validated physician general communication skills scale, administered by mailed patient survey conducted over 1 to 9 months following the clinic training period. This scale includes 6 items asking respondents to rate the quality of physician general communication skills. Response | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Physician end of life communication skills will be measured using patient responses will be measured using 4 additional questions about provider communication not included in the physician general communication skills scale over 1 to 9 months after the clinic training period 2. Staff experiences with the training and perspectives on barriers and facilitators to documenting life sustaining treatment decisions will be measured using 30-minute qualitative phone interviews, conducted with 24 staff from the 12 participating facilities at one to nine months after the clinic training period 3. Concordance between life sustaining treatments preferred and received by patients with documented life sustaining treatment decisions will be measured using a manual chart review at 18 months after the clinic training period | — |
Countries
United States of America
Contacts
Public ContactRay Frazier
Outcome results
None listed