Congestive Heart Failure, Dementia, Diabetes Complications, Frail Elderly, Leukemia, Lymphocytic, Chronic, B-Cell, Liver Failures, Chronic, Lung Disease Chronic, Malignant Neoplasm, Peripheral Vascular Disease, Renal Insufficiency, Chronic
Conditions
Brief summary
This two-year pilot study will test whether a one-page Jumpstart Form will affect goals-of-care discussions in the hospital. This form will be provided to clinicians and will include patient-specific information about preferences for goals-of-care communication and for care, as well as tips to improve this communication. Jumpstart forms will also be provided to patients or, if they are unable to communicate, their surrogates/family members. The information on the form will be obtained from questionnaires. The form is tailored to help patients and surrogates talk with clinicians about goals of care. This study is based on a successful application of Jumpstart Form in the outpatient clinic setting.
Interventions
BEHAVIORALJumpstart Intervention
The intervention has 4 steps: use electronic medical record (EHR) to identify seriously ill, hospitalized patients with no documentation of a goals-of-care (GOC) discussion during their current admission; the enrolled patient or his/her surrogate completes a survey assessing preferences for discussions about GOC, barriers to having such discussions, and current GOC which is used to create a Jumpstart form designed to prompt and guide a GOC discussion between the patient or surrogate and the clinicians caring for the patient; use natural language processing/machine learning (NLP/ML) approach to identify GOC discussions or advance directives in the EHR that occurred prior to admission and include this information on the Jumpstart form; and, deliver the Jumpstart form to the primary clinician team. The patient or surrogate is also provided with a version of the form.
Sponsors
University of Washington
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
, Patients: meeting criteria for serious illness (encompassing multiple acute and chronic illnesses) including: * those used by the Dartmouth Atlas to study end-of-life care in the US: malignant cancer/leukemia, chronic pulmonary disease, coronary artery disease, congestive heart failure, chronic liver disease, chronic renal disease, dementia, diabetes with end-organ damage, and peripheral vascular disease. * patients over age 65 with markers of frailty: albumin level \<3.0 within 48 hours of admission and weight loss of ≥10 pounds in the past year. * hospitalized patients over age 80. * English-speaking
Exclusion criteria
, Patients: * unable to complete informed consent procedures and do not have a legal next of kin * restricted information status (e.g. prisoners) * pregnant Inclusion Criteria, Surrogates: * involved in the care of an eligible patient as the legal next-of-kin * English-speaking
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Documentation of Goals of Care | At hospital discharge, an average of 2 weeks | Presence of documentation of goals of care discussions in the patient's electronic health record during the index hospitalization |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Jumpstart Intervention Jumpstart Intervention: The intervention has 4 steps: use electronic medical record (EHR) to identify seriously ill, hospitalized patients with no documentation of a goals-of-care (GOC) discussion during their current admission; the enrolled patient or his/her surrogate completes a survey assessing preferences for discussions about GOC, barriers to having such discussions, and current GOC which is used to create a Jumpstart form designed to prompt and guide a GOC discussion between the patient or surrogate and the clinicians caring for the patient; use natural language processing/machine learning (NLP/ML) approach to identify GOC discussions or advance directives in the EHR that occurred prior to admission and include this information on the Jumpstart form; and, deliver the Jumpstart form to the primary clinician team. The patient or surrogate is also provided with a version of the form. | 75 |
| Usual Care Usual in-patient hospital care. | 75 |
| Total | 150 |
Baseline characteristics
| Characteristic | Jumpstart Intervention | Total | Usual Care |
|---|---|---|---|
| Age, Continuous | 62 years | 61 years | 60 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 8 Participants | 9 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 67 Participants | 141 Participants | 74 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 2 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 10 Participants | 19 Participants | 9 Participants |
| Race (NIH/OMB) More than one race | 2 Participants | 10 Participants | 8 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) White | 62 Participants | 116 Participants | 54 Participants |
| Region of Enrollment United States | 75 participants | 150 participants | 75 participants |
| Sex: Female, Male Female | 27 Participants | 66 Participants | 39 Participants |
| Sex: Female, Male Male | 48 Participants | 84 Participants | 36 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 75 | 0 / 75 |
| other Total, other adverse events | 0 / 75 | 0 / 75 |
| serious Total, serious adverse events | 0 / 75 | 0 / 75 |
Outcome results
Primary
Documentation of Goals of Care
Presence of documentation of goals of care discussions in the patient's electronic health record during the index hospitalization
Time frame: At hospital discharge, an average of 2 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Jumpstart Intervention | Documentation of Goals of Care | 16 Participants |
| Usual Care | Documentation of Goals of Care | 6 Participants |
p-value: 0.036Fisher Exact