Effectiveness of a Brief Information About Advanced Directives in Primary Care: A Randomized Clinical Trial
Phase: NA
Conditions: Primary Care, Advance Directives, Randomized Controlled Trial
Sponsor: Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

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EFFECTIVENESS OF A BRIEF INFORMATION ABOUT ADVANCE DIRECTIVES IN 
PRIMARY CARE: A RANDOMIZED CLINICAL TRIAL 
 
Promoter of the study: Proposal of own initiative of the researcher Yolanda Rando 
Matos to present as thesis of the Master's Degree Design and Analysis of Clinical 
Investigations of the Official College of Physicians of Barcelona (COMB) of the 
thesis student Yolanda Rando Matos. 
 
Family Physicians' Team of the Basic Health Area Florida Nord de l'Hospitalet de 
Llobregat: 
 
- Yolanda Rando Matos 
- Noemí Moreno Farrés 
- Toni Vives Argilagós 
- Estrella Rodero Pérez 
- Rosa Sorando Alastruey 
- Raquel Adroer Martori 
- José Luis Ballvé Moreno 
 
Study to be presented in the design phase to the Master of the COMB. 
 
 

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ABSTRACT 
The knowledge and completion of advance directives (ADs) by the population is 
generally low. Primary care could develop a very important role to inform and 
assist in the preparation of this document because of its accessibility. 
Objective: To evaluate the effectiveness of an oral brief information and a 
brochure administered in primary care to improve the proportion of ADs records. 
Design: Randomized clinical trial. 
Ambit: 7 offices from a urban health center in Hospitalet de Llobregat which 
serves about 25,000 users older than 18 years. 
Material and methods 
It will be administered randomly triptych and oral brief information about the 
existence of advance directives for people over 18 to attend the appointment of 
their family doctor for any reason (intervention group). It will be given the 
possibility of more extensive information if they wish and collaboration will be 
offered for the advance directive according to patient preferences. The control 
group will not receive any information. Follow-up: 3 months. Variables will be: 
number of people interested in ADs, number of ADs made and demographic data 
(gender, age, education level, race, comorbidities, religion, testament) in both 
groups. Statistical analysis: multiple linear regression, Poisson and Cox as response 
analyzed, with the intervention/control group as the main variable adjusting for 
potential confounders. Bivariate comparison using Student t test or Mann-Whitney 
test (continuous variables) and chi-square or Fisher's exact test (categorical 
variables). 165 subjects were required in the control group and 165 in the 
intervention group. 
Conclusion: positive results of this study will bring out the brief information 
managed by family physicians increases the number of ADs thus facilitating the 
right to autonomy of the patient. 
 
 
Keywords: Primary care, Advance directives, Randomized clinical trial. 
 
 

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INTRODUCTION 
 
The development of biomedical science has managed to improve the quality of life 
of patients as well as increase their life expectancy. However, the therapeutic bane 
that is sometimes performed at the end of the patient's life by health professionals 
has motivated legislation on the extent of therapeutic measures that prolong life 
unnecessarily, that is, when there is no improvement quality of life. The concept of 
therapeutic effort limitation has emerged in recent years in relation to these 
ethical problems (1,2). 
The paternalistic model of the physician is increasingly relegated to the 
biopsychosocial or patient-centered model, where his preferences, beliefs and 
expectations are taken into account. Unfortunately, we can find situations where 
the patient can not express his choice in the face of aggressive treatment, for 
example in case of severe cognitive impairment or a decrease in non-reversible 
level of consciousness. These situations raise doubts and fears to relatives and 
health professionals about what the patient would have preferred had he or she 
manifested. For these reasons, in parallel with the progress of technology in 
medicine, legal attempts are being made to improve the rights of patients 
regarding their autonomy to decide on their health. 
 
Historical landmark 
The first vital wills were proposed in the United States in the mid-1960s following 
the meeting of the Euthanasia Society of America. The document was defined as 
"testament" whereby the patient could express the way he wanted to be treated if 
he could not decide for himself (3). But it was only after 1976, in the state of 
California, that they became legal. These documents already rejected vital support 
measures when there were no expectations of recovery and requested measures of 
care and treatment of pain. However, problems arose when knowing who should 
interpret the wishes of the patient, hence the figure of the representative 
appointed by the patient. Another problem was the scarce diffusion of the 
document due to barriers on the part of the sanitarians (discomfort to talk about 
the subject) and of the population (belief that it was only for the elderly or the 
chronically ill) (4). In the 1990s, attempts were made to overcome these barriers 
through meetings of experts and large-scale studies (5,6). 
 
Descriptive data of the different studies 
Studies describing the baseline characteristics of patients who formalize an 
advance directive document (DVA) provide figures for gender and educational 
level. Thus, women are twice as likely to perform the document than men in 2 
Spanish studies (7,8) and the secondary or higher education level has been related 
to a higher proportion of document completion (9,10). 
Other factors described in literature with a strong association with completing a 
VAD are having a religious denomination (9,11), having a relative with the 
document (odds ratio -OR - 17.3) (9 ), a long relationship with the general 
practitioner (OR 3.5) (9), having a larger number of children and being widowed 
(11). 
In a study of 3055 households in South Australia, it was observed that low social 
classes and people who have not made financial wills are less likely to complete 
the VAD (10). 

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There are cultural differences between the North and the South of Europe 
regarding concepts related to the end of life. According to a study carried out in 
Spain, Italy and Portugal, in these countries, more importance is given to religion, 
to being able to die at home and to family ties (12,13). 
 
Clinical trials to increase DVA registration 
A meta-analysis of the studies published between 2000 and 2012 to assess the 
effects of anticipated changes in care at the end of life showed that most of them 
are performed in a hospital setting or nursing homes (14). 
A systematic review of 2008 that evaluated the effectiveness of different 
interventions to promote early will in the elderly showed that most studies 
conducted a single educational session and measured outcomes over the next 6 
months. The mean OR calculated for the performance of the document in the 
intervention groups was 2.6 (15). In another similar systematic review but whose 
population was non-terminal patients, it was observed that the majority of studies 
were of low quality and in the most rigorous the OR was 2.42 for different 
educational interventions (written materials, videos or audios) . 
 
Different ways of increasing the realization of DVA have been studied: written 
material only, written material with a single educational session or written 
material, and educational sessions. In a review of the the literature of 2007 
concluded that only the multifaceted modalities increased the interest of the 
patients to talk about the subject with their doctors. 
 
Tamayo et al. also observed in another systematic review that the best 
intervention to increase the proportions of DVA is the combination of 
informational material and repeated conversations in clinical visits (18). 
 
 
Studies carried out in Primary Care 
It is striking the good acceptance by the population towards the DVA and the 
scarce record of it. Angora et al., In a study in which patients aged over 65 years 
were interviewed in a primary care center, found that the patients were in 
agreement with the possibility of performing the document despite the 
underutilization of this resource (19). Santos et al., Also through primary care 
surveys, found that 97% considered it interesting, 39% said they would, and 86% 
did not feel uncomfortable talking to their family doctor (20). Similar results were 
obtained by Llordés et al. in corroborating that there was little information and 
much interest in this process (21). 
The citizens' assessment of the possibility of making a document of advance 
directives is very positive, but only 1.9% in Catalonia and 0.5% in Andalusia of the 
respondents had done it (22,23). In Andalusia, it was also seen the importance of 
the information leaflet in the health center to increase satisfaction. (23) 
Regarding intervention studies to increase the records of DVA performed in 
Primary Care, we have that of Donahue et al. who obtained a 32.5% increase in 
VAD by mailing the information prior to the arranged visit with their family doctor 
and completing it in successive visits in a period of 3 months (24). 
Wisow et al., In a quasi-experimental study of 1 year duration, promoted the 
anticipated will in over 65 in health centers through oral and written education (a 
letter prior to a control visit and a subsequent reminder visit) administered by 

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family doctors and used another health center as a control. The result was an 
increase of 7'8% of registrations with respect to <1% in the control center (25). 
According to another study in Primary Care (Ramsaroop, 2007), the information 
leaflet alone is not effective and the best would be multiple educational visits to 
promote the attitude change phase towards the ADs procedure (26). 
 
Hypothesis of the study 
 
Giving brief oral and written information to patients visited by your family doctor 
on a prior appointment increases the proportion of DVA records by 8%. 
Providing a brief oral and written information to patients visited by their family 
doctor in a previous appointment increases the proportion of people interested in 
this right (there is no previous bibliography on this data). 
People who write a DVT are usually older, white, women, have more children, have 
a will and have more comorbidity than those who do not. 
 
MAIN OBJECTIVE 
To evaluate the effect of brief oral and written information on the advance 
directive document (DVA) administered by primary care physicians, compared to 
usual clinical practice, on the proportion of persons interested in or performing 
the VAD in 3 months in the adult population (over 18 years old) who attend a 
Primary Care appointment. 
 
SECONDARY OBJECTIVES 
Evaluate the baseline characteristics of those who perform or are interested in 
VAD (whether they are in the control or intervention group). 
To assess the baseline characteristics of those performing the DVA and those not 
within the intervention group. 
Evaluate the reasons why patients finally formalize the document by open 
question (will be categorized if there is a limited number of responses, otherwise 
the reasons will be described qualitatively). 
Evaluate the average time to perform the DVA from the day of the patient's 
recruitment. 
MATERIAL AND METHODS 

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Design 
Parallel group unicentric randomized clinical trial. Prospective primary care 
intervention study. 
For randomization, randomly generated numbers will be used in closed envelopes 
controlled by a professional outside the study. Subsequent masking is not 
appropriate for the patient. The randomization unit will be the patient. 
Sample 
Open-label (or non-blind) unicentric randomized clinical trial of parallel groups. 
Simple random sample of patients who go to an appointment with their family 
doctor. 
Inclusion criteria: Patients older than 18 years old who go to their family doctor by 
appointment. 
Exclusion criteria: 
- Patients with language barrier 
- Patients younger than 18 years (AD not provided for by law) (28) 
- Patients with altered decision-making ability according to computerized clinical 
history by coding in health problems or mentioned in a clinical course of 
computerized medical history (eCAP): cognitive impairment, dementia, mental 
retardation diagnosed. Although there are studies on attitudes towards ADs of 
people with early cognitive impairment (Minimental> 18), it was decided to 
discard because the intervention should be brief. The cited study also concludes 
that this type of patients prefer to delegate decisions to the family. (29) 
- Patients who come spontaneously to their family doctor. 
- Patients who have already been recruited previously in the study. Patients who 
may visit by appointment only on more than one occasion will only participate 
once and subsequent visits for recruitment will be excluded. In addition, there will 
be no reinforcement of the study intervention in these visits. 
- Patients who have already formalized the ADs. 
- Patients who do not wish to participate in the study. 
Calculation of sample size: In order to know the magnitude of the effect of similar 
studies in primary care with similar interventions (written and oral information vs 
no intervention), the Wissow study (25) was chosen, where the proportion of VAD 
obtained in intervention group was 7.8% vs. <1% in the placebo group. 
In calculating proportions in cohort studies or clinical trials: 

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Accepting an alpha risk of 0.05 and a beta risk of 0.2 in a bilateral contrast, 165 
individuals in the intervention group and 165 in the control group are required to 
detect a minimum relative risk of 7.8 (= 7.8% / 1% ) taking the rate of VAD in the 
intervention group as 7.8% and in the control group of 1%. A rate of loss has been 
estimated for refusing the 10% share. The POISSON approximation has been used 
in the statistical calculator GRANMO, version 7.12 online (Program of Research in 
Inflammatory and Cardiovascular Disorders, Institut Municipal de Investigació 
Mèdica, Barcelona, Spain) 
 
Although hypothetically no losses are expected, they may have been relinquished 
to participate for different reasons. In order to avoid a selection bias produced by 
the relationship of giving up with the fact of wanting to do a VAD, patients refusing 
to participate will be excluded and the motive, age and sex will be collected to 
compare if there are differences between the two groups regarding these 
characteristics. 
Ambit 
Florida Nord de l'Hospitalet de Llobregat Primary Care Center, an urban area with 
a population of approximately 25,000 people. Multicultural neighborhood with low 
socioeconomic status. The follow-up time for the intervention will be 3 months. 
Information sources 
Records of shared clinical history in eCAP. Patient questions about independent 
variables if they are not recorded. 
Recruitment procedure 
Consecutive recruitment: They will be consecutively obtained from different 
quotas (both afternoon shift and morning shift) so that the sample is 
representative of the study population. 
Participate the quotas of the center whose doctor in charge has wanted to 
participate in the study. In order to avoid a selection bias and a more active doctor 
than another to have more patients represented in the study, a mechanism will be 
established whereby everyone will have the same probability of recruiting a 
similar number: the first 6 visits of each day for 8 days . The recruitment period 
will be made from 01/06/2015 to 09/30/2015, until the sample is completed. The 
follow-up period will be 3 months for each patient (both intervention and control). 
A list of random numbers will be created and divided among the 7 consultations of 
the participating physicians in the study. Each day, the first 6 visits to the list will 
be recruited for 8 days prior appointment or until the sample is completed. 
Patients will be randomized according to the list of random numbers guarded by a 
professional (or several) other than the study that will be located in the adjacent 
consultation. In case there is no professional close, the list will be delivered with a 

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closed envelope to another professional and will be contacted by telephone. 
Patients will be treated with the intervention when the number is 1 and control if 
it is 0. This number will be asked prior to the patient's entry into the consultation. 
 
Predictive or independent variables to be obtained at the time of the first visit 
 
For stratified analysis. 
- Sex: Male, Female 
- Race: Caucasian vs non-Caucasian 
- Age in years 
- Level studies: Primary, secondary, university, without studies. 
- Comorbidity: measured by the Charlson index. Score: a) 0-1: no comorbidity; b) 
2: low comorbidity; c) ≥3: high comorbidity. 
(Charlston.webloc calculator). 
- Testament on material goods: Yes, no. 
- Religious Confession: yes, no. Is considered a practitioner: yes, no 
- Marital status: single, married, widowed, separated / divorced 
- Number of children 
 
To obtain this information will be extracted from the computerized medical 
history or the patient will be asked. 
Intervention 
Patients who are included in the intervention group, if they meet the inclusion 
criteria and do not present any exclusion criteria, will be given brief information 
about the existence of the document of anticipated wills after resolving the reason 
for the visit for which they had come the patient. This information will not last 
more than 3 minutes and will not be repeated on successive visits within the 
recruitment period. Also, an informative triptych (see attachments) will be given 
to the patient so that he can read it at home. These leaflets have been made by the 
Department of Health of the Generalitat de Catalunya. They will be advised that we 
can extend the information if they are interested or help them to do the document 
in the near future if they want, we will inform you that we would wait for the 
answer before 3 months (24). In case of interest, you can leave your information in 
the User Service of the outpatient clinic by specifying name, telephone number and 
reference doctor or ask for an appointment again. 
  
Patients who fall into a control group will only be attended to their reason for 
visiting and will be asked for the necessary data to obtain the independent 
variables if they do not appear in their history. If the patient in this group wants 
the information, he will be excluded from the study because he "refuses to 
participate." 
 
If the patient, both the control group and the intervention group, has some 
exclusion criteria, it will be recorded as a screening failure and their 
randomization number will not be re-used for the next patient. 
 
All patient information will be kept confidential. 
 

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Result or dependent variables 
They will be obtained at the moment that the patient shows interest in the 
intervention, or else, by asking by appointment or by telephone within 3 months of 
their recruitment: 
- Interest in information about DVA: yes, no. Number of patients who have come to 
their family doctor (MF) to request information or have been interested by 
telephone in each group. 
- Implementation of DVA: yes, no. Number of patients in each group. 
In case of not being able to contact the telephone patient or face to face at 3 
months, the DVA registration will be viewed at the Primary Care Clinic Station 
(eCAP), which is the computerized medical history program used by all 
professionals in the network of primary care of the Institut Català de la Salut (ICS). 
The document can be accessed from: 
• HC3 - Notices: shared clinical history projects in Catalonia. 
• Dades del pacient: Documents of anticipated voluntats 
Registration from the Department of Health is autonomous, although not done in 
the ABS. From other institutions, the patient is always advised to take the DVA to 
his health center. 
- Open question to know the reason that has led to formalize the DVA, both to 
patients in the intervention group and control. 
- Time to perform the DVA from the day of recruitment, expressed in days, to both 
the intervention and control patients. 
 
Limitations and ethical considerations 
- Possible increase in response in the intervention group due to the link with the 
family physician (participation bias). It could be wrongly concluded that the 
intervention is effective when compared to the control group. Randomization of 
the sample is intended to partially avoid this problem. 
- Possible contamination of the groups when living in the same neighborhood and 
the possibility of communication between the patients in the control group and the 
intervention group. To find out this, patients in the control group will be asked to 
become interested or to do DVA if they have been informed by other patients of the 
study through the questions: Do you know anyone else who participates in this 
study? Did you talk about the study with that person? 
- Bias of hyper-attendees: they are more likely to be chosen for the study however 
this problem is within usual clinical practice. The information will not be repeated 
to the patient who has already been randomized. 
 
The study has been submitted to the Ethical Committee for Clinical Research 
(CEIC) of the University Institute for Research in Primary Care (IDIAP) Jordi Gol, 
and is awaiting the results of its evaluation. When accessing the eCAP and / or 
performing a personal interview to complete information on the variables is 
required, the patient's signed informed consent will be requested through his 
physician. The confidentiality of the subjects included in the study will be 

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guaranteed according to the Organic Law on Protection of Personal Data (15/1999 
of December 13, LOPD). Researchers are committed to maintaining the 
confidentiality of information, working with anonymous patient data, and 
respecting current ethical and research practice standards. 
Statistical Analysis Plan (SAP) 
Intention-to-treat analysis. No intermediate analysis is planned. A bilateral 
significance level of 5%, 95% CI and 80% power will be used. The SPSS V21 
program will be used. Analysis of efficacy of unadjusted parallel clinical trials. 
Data will be analyzed according to the CONSORT guidance and comparisons 
between groups will be based on the intention-to-treat principle. First: analysis of 
the baseline comparability of the study groups in relation to the variables studied. 
Descriptive statistics of all variables collected. The Student's t test or the Mann-
Whitney U test (according to the frequency distribution of the variables studied) 
will be used to compare continuous variables, and Chi-square or Fisher's exact test 
for comparison of categorical variables. 
In the case of finding a very different distribution of the independent baseline 
variables (1st visit) between the two groups, which would indicate an obvious 
selection bias despite randomization, the possibility of analyzing as a cohort study 
by means of propensity score techniques . 
 
• Main objective "To assess the effect of brief oral and written information on the 
Advance Directives (ADs) given by primary care physicians, compared to usual 
clinical practice, on the proportion of persons interested in or performing VAD in 3 
months in a heterogeneous group of patients (different ages and ethnicities) who 
go to a previous appointment ": inferential analysis of effectiveness, analysis of 
proportions of two samples. A multivariate logistic regression analysis with the 
variables of interest or realization of the yes / no VAS as the dependent variable 
will be performed and the group assigned as an independent variable, adjusting for 
the potential confounding factors. 
 
• Secondary objectives: demographic and clinical characteristics that are 
considered likely to be associated with the completion of a priori VAD or that differ 
between study groups will be included in the logistic regression model for the 
dichotomous dependent variable. 
 
1 · "Evaluate the baseline characteristics of those who perform or are interested in 
the VAD of both the control group and the intervention group": descriptive 
analysis for independent quantitative variables (age, number of children) and for 
qualitative variables , studies, comorbidity, religion, testament, marital status), 
frequency tables. Bivariate analysis using as a dependent variable the answer yes 
or no to the realization of the DVA or interest by DVA and as independent variables 
the basal characteristics. The Student's t test or the Mann-Whitney U test 
(according to the frequency distribution of the variables studied) will be used to 
compare continuous variables, and Chi-square or Fisher's exact test for 
comparison of categorical variables. 
2 · "Evaluate the baseline characteristics of those who perform the VAD and those 
who are not in the intervention group": descriptive analysis for independent 
quantitative variables (age, number of children) and for qualitative variables 
(gender, race, comorbidity, religion, testament, marital status), frequency tables. 

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Bivariate analysis using as a dependent variable the answer yes or no to the 
realization of the VAD within the intervention group and as independent variables 
the basal characteristics. The Student's t test or the Mann-Whitney U test 
(according to the frequency distribution of the variables studied) will be used to 
compare continuous variables, and Chi-square or Fisher's exact test for 
comparison of categorical variables. 
3 · "Evaluate the reasons why the document is formalized by open question": it will 
be categorized if there is a limited number of categories of responses and a 
descriptive univariate analysis will be done (frequency tables). In case of multiple 
answers the reasons will be described qualitatively. 
4 · "Evaluate the average time to perform the DVA from the day of recruitment of 
the patient.": Univariate descriptive analysis. 
 
SCHEDULE OF ACTIVITIES 
 
o Implementation of the protocol: From October 2014 to May 2015. Directed by 
Antoni Vives, Noemi Moreno and Yolanda Rando. 
o Ethical committee approval and health authorities: will be sent to USR 
Metropolitana Nord (Jesús Almeda): April –June 2015. The shipment will be made 
by Yolanda Rando. 
o Recycling in advance wishes of the researcher: 2 sessions of 1 hour given by the 
lecturer: 2 days of May 2016. 
o Inclusion of the first and last patient: From 1 to 30 September 2016. Conducted 
by participating physicians: Toni Vives, Noemí Moreno, Estrella Rodero, Rosa M. 
Sorando, Raquel Adroer Martori, José Luis Ballvé, Yolanda Rando. 
o Completion of the last patient follow-up: From 1 to 30 December 2017. 
Conducted by participating physicians: Toni Vives, Noemí Moreno, Estrella Rodero, 
Rosa M. Sorando, José Luis Ballvé, Raquel Adroer Martori , Yolanda Rando. 
o Availability of results report: January-February 2017. Directed by Yolanda Rando 
o Plan validation data: March 2017. Directed by Yolanda Rando 
 
NECESSARY RESOURCES 
 
The study will be carried out at the Florida Nord EAP of L'Hospitalet de Llobregat, 
which has a long history as a teaching center attached to the Unitat Docent 
Multidisciplinary Family Medicine and Community of Ponent Coast. 
Some of the researchers are tutors of this teaching unit. 
The Florida Nord EAP has a computerized medical history since 2005. 
We have the consultations, the computer resources and clinical tool consumable or 
inventoried necessary for the realization of the study. All visits and subpoenas will 
be in charge of the research team. 
 
o Paper or electronic data collection questionnaires 
o Informative triptychs on paper 
or Google drive to share documents and bibliography. 
o Clinical Data Manager: SPSS v 21 mac statistical package. 
o Medical personnel participating in the study: 7 family physicians 
or Nurse who keeps the list of random numbers (outside the study): 6 nurses 
o Administrative staff of the outpatient clinic for the introduction of the DVA in the 
computerized medical records: 2 administrative 

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IMPACT OF THE PROPOSED INVESTIGATION 
 
This research aims to improve the patient's quality of life by reporting on a right 
that is often underused and that has repercussions on respect for autonomy. It 
would avoid unnecessary referrals to the hospital, performing complementary 
tests, applying invasive techniques and unnecessary prolongations of life if that 
was the patient's decision and was documented. It will bring benefits to the 
community, both at the level of patients and professionals, allowing the latter to 
have no uncertainties in the specific situations contemplated by the DVA. 
The results of this study can be extrapolated to other communities and can 
transfer the knowledge generated by updating new guidelines and protocols of 
action in Primary Care. 
In addition, new data will be obtained on a type of little-used intervention that will 
affect the expansion of the scientific literature. 
 
 
EXPERIENCE AND CAPACITY OF THE RESEARCH GROUP SUBMITTING THE 
PROPOSAL 
 
Tesinanda Yolanda Rando Matos: Adjunct physician at the center. She is an expert 
in the incorporation of new technologies into the clinical practice of primary care, 
being a reference of her center for diagnostic techniques such as the use of the 
non-mydriatic chamber and therapeutics such as cryotherapy. She has 
collaborated in multicenter clinical trials as an associate researcher. He has 
attended several editions of the Conference of the ethics group of CAMFiC. 
 
Antoni Vives Argilagós: Adjunct physician and teaching coordinator of the Center 
since its opening. Extensive experience as a tutor, both undergraduate and 
postgraduate. Experience in research in general focused mainly in the 
cardiovascular area, in implementation of new teaching techniques and specifically 
in the approach of ethical problems with the doctors in formation. He has attended 
several editions of the Conference of the ethics group of CAMFiC. He has 
collaborated in multicenter clinical trials as an associate researcher. 
 
Noemi Moreno Farrés: Adjunct physician at the center. Experience as tutor, both 
undergraduate and postgraduate. It is referent of the center in respiratory 
pathology. She has collaborated in multicenter clinical trials as an associate 
researcher. He has attended several editions of the Conference of the ethics group 
of CAMFiC 
 
Estrella Rodero Pérez: Adjunct physician at the center. She is expert in the control 
of the processes of Disability, temporary, being a reference of its center for 
techniques and therapeutics such as Infiltrations of locomotive apparatus and 
ambulatory minor surgery techniques. She has collaborated in multicenter clinical 
trials as an associate researcher. He has attended several editions of the 
Conference of the ethics group of CAMFiC. 
 
 

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Rosa Mª Sorando Alastruey: Adjunct physician at the center. She is an expert in the 
incorporation of therapeutic techniques into the clinical practice of Primary Care 
as the infiltrations of the locomotor system. She has collaborated in multicenter 
clinical trials as an associate researcher. He has attended several editions of the ICS 
Symposium. 
 
Raquel Adroer Martori: Adjunct doctor of the center. Extensive experience as a 
tutor, both undergraduate and postgraduate. Experience in research in general 
focused mainly on the cardiovascular area.). He has attended several editions of 
the ICS Symposium. He has collaborated in multicenter clinical trials as an 
associate researcher. 
 
José Luis Ballvé Moreno: is a member of the Accredited Research Group on 
Lifestyles of the IDIAP Primary Care Research Institute Jordi Gol. It has helped to 
translate the results of clinical research into the 
daily practice of primary care as Co-author of the "Guide for the detection and 
treatment of tabac consumption" (Guia Salud), researcher of ISTAPS study and as 
teacher in workshops and courses for smoker care. In 2009 he participated as a 
teacher in the course of urgent pathologies in primary care. He has collaborated in 
multicenter clinical trials as an associate researcher, currently a principal 
investigator of a multicenter clinical trial. 
 
 
 
 
 
 
 

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ANNEXES 
 
Annex 1: Triptych DVA Spanish 
Annex 2: Triptych DVA Catalan 
Annex 3: Patient information sheet in Spanish 
Annex 4: Patient information sheet in Catalan 
Annex 5: Informed Consent in Spanish 
Annex 6: Informed Consent in Catalan 
 
 
Annexes 1 to 6 in separate document.

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