Emergencies
Conditions
Brief summary
A randomized controlled trial of a video decision aid in the Emergency Department Setting to improve advance care planning documentation.
Detailed description
A randomized controlled trial of a video decision aid in the Emergency Department setting shown to patients followed by a brief advance care planning discussion and then relay that discussion to the patient's primary care provider and/or admitting clinical team and look at rates of advance care planning documentation in the electronic health record over time. Primary outcome is advance care planning documentation in the EHR at 3 months.
Interventions
BEHAVIORALvideo decision aid
advance care planning video decision aid
BEHAVIORALcontrol arm ACP information sheet
control arm ACP information sheet
Sponsors
University of California, Davis
National Institute on Aging (NIA)
Massachusetts General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Masking description
Primary outcome will be obtained through natural language processing (NLP) from the EHR, in which the RA conducting the NLP will not know which arm of the study the patient was in.
Intervention model description
RCT
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* anyone aged 65 and over or anyone aged over 50-64 with an indicator of serious illness
Exclusion criteria
* non english or spanish speakers those with a POLST legally blind medically non stable requiring ICU level care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| EHR documentation of advance care planning | 3 months | EHR documentation of advance care planning |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| concordance between stated and documented preferences | at 3 and 6 months | concordance between stated and documented preferences |
| ACP documentation in the EHR | at 6 months | ACP documentation in the EHR |
| hospitalization | at 3 and 6 months | hospitalization |
| differential intervention effects of the ACP video intervention on patient ACP documentation based on race and ethnicity | at baseline, 3 and 6 months | We will look at ACP documentation in the intervention and control arms to see if there are differential intervention effects based on race and ethnicity. We will look at the ACP documentation rate in Whites in both arms, and compare them to African Americans and Latinx populations. We will be able to see if the intervention had a greater or lesser effect on ACP rates in sub groups of our population by race and ethnicity. |
| quality of clinician ACP communication using an ACP quality communication survey | quality of communication at the time of the survey interview (baseline), and then at 3 and 6 months | quality of ACP communication using an ACP quality communication survey |
| place of death | at 3 and 6 months | place of death |
| enrollment in hospice | at 3 and 6 months | enrollment in hospice |
| ED visits | at 3 and 6 months | ED visits |
| patient reported conversations with health care providers and family | at 3 and 6 months | patient reported conversations with health care providers and family |
| ICU days | at 3 and 6 months | ICU days |
| patient CPR and breathing machine preferences | at time of survey (baseline) and then after 3 and 6 months | we will ask the patient whether or not they want CPR attempted and whether they would wish to be placed on a breathing machine |
| patient preferences for goals of care | at time of survey (baseline) and then after 3 and 6 months | We will ask patient if they wish to receive life prolonging care, limited care or comfort care. |
| decisional certainty regarding decision making for ACP preferences | at baseline survey interview | we will ask patients how certain they are about their decisions for the goals of care |
| patient knowledge of ACP | at baseline survey interview | We will ask patients knowledge questions about their understanding of advance care planning |
| patient confidence in health care delivery that is aligned with patient preferences | at time of survey (baseline) and then after 3 and 6 months | We will ask patients how confident they are in that they will receive the type of medical care they wish in their health care system |
| patient ACP engagement with ACP topics | at baseline survey interview | We will ask patients how ready and engaged they are with the topic of advance care planning |
| mortality | at 3 and 6 months | mortality |
Countries
United States
Outcome results
None listed