Designating a Healthcare Proxy
Conditions
Keywords
healthcare proxy, advance care planning, end-of-life care, surrogate decision-maker, durable power of attorney, behavioral economics, pre-commitment
Brief summary
This study is a Stage III randomized trial to encourage patients in advance of a health care appointment to designate a healthcare proxy. Patients will be randomly assigned to receive a mailer containing information about designating a healthcare proxy, or to not receive any mailer. For patients assigned to receive a mailer, the mailer will differ by the presence or absence of a patient pre-commitment prompt, and contain a personalized provider request or a generic health system request. The work will evaluate the randomized trial and identify factors that predict intervention effectiveness.
Interventions
BEHAVIORALMailer
Patient mailers will ask the patient to name a healthcare proxy at their next primary care visit.
BEHAVIORALProvider Request
Patient mailers will be sent from and signed by the patient's provider for their next scheduled primary care visit.
BEHAVIORALPre-commitment Prompt
Patient mailers will contain a box that asks the patient to bring a form with their choice for a healthcare proxy to their next primary care visit.
Sponsors
University of Southern California
National Institute on Aging (NIA)
Contra Costa Health
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
Hospital staff, including clinicians, will not be alerted to the patient's assigned intervention. However, clinicians may learn of the patient's assigned intervention if the patient brings their mailer to the visit.
Intervention model description
2 x 2 factorial + a no intervention control group
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* No EHR-documented healthcare proxy at enrollment * Age ≥ 55 years OR age ≥ 18 years and listed in the health system's cancer, CHF, or CKD registries
Exclusion criteria
* Primary care provider not assigned at time of randomization.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients with EHR-documented healthcare proxy | From randomization through 30 days after the patient's scheduled index primary care visit date | Documentation in the electronic health record of a healthcare proxy |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients with legal advance care planning documentation | From randomization through 30 days after the patient's scheduled index primary care visit date | Documentation in the electronic health record of any legal advance care planning document, including an advance directive or power of attorney |
| Proportion of patients that attended scheduled visit | On the date of the patient's scheduled index primary care visit | Patient attended the scheduled primary care visit |
| Proportion of patients with EHR-documented healthcare proxy through 90 days | From randomization through 90 days after the patient's scheduled index primary care visit date | Documentation in the electronic health record of a healthcare proxy |
| Proportion of patients with legal advance care planning documentation through 90 days | From randomization through 90 days after the patient's scheduled index primary care visit date | Documentation in the electronic health record of any legal advance care planning document, including an advance directive or power of attorney |
| Proportion of patients with primary care visit through 90 days | From randomization through 90 days after the patient's scheduled index primary care visit date | Patient attended a primary care visit |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORMireille Jacobson, PhD
University of Southern California
Outcome results
None listed