Surgical Advanced Care Planning
Conditions
Brief summary
The goal of the Advanced Care Planning (ACP) study is to encourage patients aged 65 or older who are referred for elective surgery to have advanced care planning.
Detailed description
ACP is also a critical way to support older adults in participating actively with clinicians in making real-time, complex medical decisions so that the medical care they receive is aligned with their goals. Our team has designed and tested a theory-based, interactive ACP patient-facing technology solution (PREPARE) based on the new ACP paradigm of preparing people for communication and medical decision-making. The study team hypothesizes that by including PREPARE into the EHR-centric pre-surgery workflow for older adults and including automated patient reminders, easy-to-read materials, and, in Arm 3, directed support from a healthcare navigator (HCN), they can empower patients and surgical teams to engage in ACP discussions. They also hypothesize that ACP documentation will increase more with increasing resource intensity (i.e., Arm 3 more than Arm 2 more than Arm 1). Participants will be randomized to Arms: (1) Letter about ACP, PREPARE advanced directive (AD), PREPARE website; (2) Letter, advanced directive (AD), PREPARE plus reminder messages; (3) Letter, advanced directive (AD,) PREPARE plus reminders plus a healthcare navigator on ACP documentation (clinically meaningful ACP, primary outcome). All patients randomized to the intervention will be sent a patient-reported ACP engagement survey (secondary outcome).
Interventions
BEHAVIORALLetter
Letter about ACP
BEHAVIORALAD
PREPARE advanced directive (AD)
BEHAVIORALPREPARE website
PREPARE website
BEHAVIORALreminders
reminders to complete the advance directive
BEHAVIORALhealthcare navigator
healthcare navigators provide assistance to complete the advance directive
Sponsors
University of California, Irvine
University of Minnesota
National Institute on Aging (NIA)
Fairview University Medical Center
University of California, San Francisco
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Caregiver)
Intervention model description
1:1:1 simple randomized block design stratified by enrollment site
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
\- Older Adults (age 65+) referred for surgical evaluation
Exclusion criteria
1. ACP on file within 3 years prior to surgery (UCSF and UCI) and 5 years (UMN) 2. Was previously randomized into intervention for a prior surgery during the 18-month study period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants with clinically meaningful Advanced Care Planning | 6 months | clinically meaningful ACP documentation (ACP-specific clinical notes, problem lists, Epic Smartforms or Smartphrases, advanced directives, Physician Orders for Life Sustaining Treatment, out of hospital do-not-resuscitate order, living wills, or CPT billing codes) available in the HCS EHR within 6 months of intervention. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Engagement Scores | 6 months | Patient-centered outcomes will be derived from the validated 4-item ACP Engagement Survey.The survey will be administered 2 weeks after the pre-surgical clinic visit and a follow up survey will be sent 6 months later. |
Countries
United States
Contacts
Primary ContactElizabeth Wick, MD
Backup ContactIrina Gorodetskaya
Outcome results
None listed