End Stage Disease, Health Care Utilization
Conditions
Brief summary
The goal of this research is to increase patients' knowledge about advance care planning (ACP) discussions and hospice care for patients with serious illness receiving home-based care.
Detailed description
ACP is a process that allows patients to communicate their wishes and preferences or medical care, when they are seriously ill, to their medical providers. The study investigators would like to assess whether a home-ACP video can improve patient-clinician communication about patients wishes for their medical care and lead to more patient-centered care. This study is a randomized clinical trial of a Home-ACP intervention among 500 adult patients with serious illness receiving medical care at home with the Clover Health House Calls Program. Study participants will be assigned to one of two groups. In one group, participants will continue to receive usual care with their home-based care team. In the second group, participants will continue to receive their usual care with their home-based care team and also view an ACP video that helps them understand ACP and provides education about ACP and hospice care.
Interventions
BEHAVIORALHome ACP Video
A video focused on Advance Care Planning and Hospice for patients with serious illness
Sponsors
Massachusetts General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Masking description
The research team collecting study outcomes will be blinded to group assignment
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Aged 21 or over * Have a one-year prognosis or less as determined by Clover Health's validated algorithm * Speak either English or one of the other 25 languages in which the video intervention is available
Exclusion criteria
* Visually impaired beyond 20/200 corrected * Acute psychiatric illness or other comorbid condition that impairs cognitive ability to participate in advance care planning discussion as determined by the primary House Call Provider.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospice utilization | up to one year follow-up or death | Compare the use of hospice (yes vs. no) between the study groups |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospice length of stay | up to one year follow-up or death | Compare hospice length-of-stay between the study groups |
| Rates of documented resuscitation preferences in the Electronic Health Record | up to one year follow-up or death | Compare documented resuscitation preferences in the Electronic Health Record between the two groups |
| Rates of Advance Care Planning documentation in the Electronic Health Record | up to one year follow-up or death | Compare advance care planning documentation in the Electronic Health Record between the two groups |
| Patient knowledge about Advance Care Planning | Up to two days following the intervention visit | Compare patient's knowledge about advance care planning using a 5-item knowledge questionnaire (range 0-5), higher score indicate more knowledge |
| Patient reported confidence in care | up to two days following the intervention visit | Compare patient's reported confidence in their medical care using a single Likert response question between the two study groups. Score range from 0-4. Higher scores indicate higher confidence in care |
| Patient reported satisfaction with clinician communication | up to two days following the intervention visit | Compare patient satisfaction with their communication with their clinician using the CAHPS subscale. Score range 0-20. Higher score indicate better satisfaction with communication |
| Patient reported decisional satisfaction | up to two days following the intervention visit | Compare patient reported decisional satisfaction between the study groups using the Satisfaction with Decision Scale. Scale range from 6-30. Higher scores indicate higher satisfaction with decision |
| Patient reported decisional certainty | up to two days following the intervention visit | Compare patient reported decisional certainty between the two groups using the Decision Conflict Scale. Score ranges from 0 to 100. Higher scores indicate higher decisional conflict |
Countries
United States
Contacts
CONTACTAreej El-Jawahri, MD
Outcome results
None listed