Advance Care Planning, Emergency Department, Motivational Interviewing
Conditions
Brief summary
ED GOAL is a 6-minute, motivational interviewing, advance care planning intervention. In this study, the investigators will pilot test (Part I) ED GOAL by training research nurses to demonstrate its intervention fidelity and acceptability on older adults with serious illness in the emergency department (ED). Upon demonstrating the intervention fidelity of this intervention in Part I, the investigators will collect patient-centered outcomes (Part II) of 100 older adults with serious illness after leaving the ED. Further in Part III, the investigators will conduct a survey to the participants' outpatient clinicians to find out how to optimize the care coordination from the ED to the outpatient office to facilitate advance care planning conversations.
Interventions
BEHAVIORALED GOAL Nursing
A brief (\<7minutes) interview by an emergency department nurse to empower patients to formulate and communicate their goals for medical care with patients' outpatient clinicians.
Sponsors
National Institute on Aging (NIA)
Cambia Health Foundation
Brigham and Women's Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Part 1. Inclusion Criteria: * ≥50 years of age AND ≥1 Serious illness\* OR ED clinician would not be surprised if patient died in the next 12 months * English-speaking * Capacity to consent
Exclusion criteria
* Acute physical or emotional distress * Determined by EM physician not to be appropriate * Clearly documented goals for medical care\*\* (Unless the treating clinician recommends that the patient needs the intervention) * Delirium (assessed using 3D-CAM) * Mild cognitive impairment or dementia (assessed using MiniCog or SBT) * Already enrolled in this study * Unable/unwilling to schedule the follow-up outcomes assessment on the calendar. Part 2. Inclusion Criteria: * ≥50 years of age AND ≥1 Serious illness\* OR ED clinician would not be surprised if patient died in the next 12 months * English-speaking * Patient with mild cognitive impairment or mild dementia with caregiver has a capacity to consent * Caregivers of patients with moderate/severe dementia has a capacity to consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Measurement of Intervention Fidelity | Immediately after the the intervention | Measure the intervention fidelity of ED GOAL Nursing administered by trained research nurses to seriously ill older adults or caregivers of patients with cognitive impairment in the ED (N=30). Trained research nurses will demonstrate intervention fidelity \>70% on a prespecified checklist. |
| Measurement of change in ACP conversations before and after the intervention | Before and one month after the intervention | Conduct a pre-/post-intervention study (N=100) of ED GOAL Nursing on advance care planning (ACP) conversations one month (28 days) after leaving the ED (confirmed by EMR documentation of new/changes in ACP conversations, advance directive forms, or healthcare proxy, as well as changes in patient's or caregiver's self-reported ACP engagement). ≥25% of participants will have reported completing an ACP conversation, or changed advance directive forms or healthcare proxy, or change in patient's or caregiver's self-reported ACP engagement at one month after leaving the ED. |
| Identification of key care coordination components from outpatient clinicians. | One month after the intervention | Conduct a survey on the outpatient clinicians of ED GOAL study participants one month (28 days) after the participating patients leave the ED to identify key care coordination components to maximize the intervention efficacy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient-reported ACP conversation after the intervention | One month after the intervention | Conduct a survey on the patients to ask if they report having new ACP conversation after the intervention. The outcome is dichotomous (yes or no). |
| Documentation of new ACP in the electronic health records | Before and one month after the intervention | Conduct a chart review to find new documentation of advance care planning including new health care proxy form, new medical order for life-sustaining treatment, and new clinicians' free-text documentation of ACP conversations. |
Countries
United States
Outcome results
None listed