Please select the eligibility criteria that correspond to the clinical trial below.
Title: An Effectiveness-Implementation Trial of SPIRIT in ESRD
Brief Summary: Despite advances in dialysis, only 50% of dialysis patients are alive 3 years after the onset of end-stage renal disease (ESRD). Although withdrawal of dialysis precedes 1 in 4 deaths of patients with ESRD, withdrawal from dialysis and aggressive treatment is rarely discussed by patients and their surrogates with sufficient time to consider alternatives such as hospice or dying at home. Over the last decade, the researchers have developed and iteratively tested a patient and family-centered advance care planning intervention based on the Representational Approach to Patient Education called "Sharing Patient's Illness Representation to Increase Trust" (SPIRIT). SPIRIT is a 6-step, 2-session, face-to-face intervention to promote cognitive and emotional preparation for end-of-life decision making for patients with ESRD and their surrogates.

This study is a multicenter, clinic-level cluster randomized trial to evaluate the effectiveness of SPIRIT delivered by dialysis care providers as part of routine care in free-standing outpatient dialysis clinics compared to usual care plus delayed SPIRIT implementation. The researchers will recruit 400 dyads of patients at high risk of death in the next year and their surrogates from dialysis clinics in four states. Patients and surrogates will complete questionnaires at baseline and two weeks after the intervention. Surrogates will complete a post-bereavement assessment three months after the death of the patient.


Options:
A: Inclusion Criteria:

* Diagnosis of dementia from Alzheimer's or other underlying cause
* Global Deterioration Scale (GDS) Stage 5, 6 or 7
* acute illness hospitalization

Exclusion Criteria:

* No English-speaking family decision-maker
* Primary physician expects study to be too stressful for family caregiver
B: Inclusion Criteria for Patients:

* on either hemodialysis or peritoneal dialysis
* able to understand and speak English

Exclusion Criteria for Patients:

* lack of an available surrogate
* too ill or cognitively impaired to participate based on clinicians' judgment
* already enrolled in hospice

Inclusion Criteria for Surrogates:

* are chosen as a surrogate by the patient
* paid caregivers who will not be participating in medical decisions for the patient

Exclusion Criteria for Surrogates:

* Unable to complete questionnaires due to physical or cognitive limitations
C: Inclusion Criteria:

Patient Inclusion Criteria

1. Age 18 or older
2. Speaks and reads English
3. Diagnosed by a specialist at either Johns Hopkins Medical Institutions or University of Chicago Medical Center as having ALS or stage III or IV GI or pancreatic cancer.
4. Accompanied to clinic by a family member who may participate in the patient's health care decisions and who patient gives permission to approach for participation in study.
5. Lives within a 2-hour drive of The Johns Hopkins Medical Institutions or The University of Chicago Medical Center

5.G.2. Family Inclusion Criteria

1. Age 18 or older
2. Speaks and reads English
3. Identified by the patient-subject as a family member whom the patient may involve in health care decision making in the present and/or should the patient become too ill to make health care decisions.
4. Person who the patient-subject has granted investigators permission to approach for participation in this study.

Exclusion Criteria:

* Patient Exclusion Criteria

  1. Severe visual impairment that would limit ability to visualize instrument illustrations
  2. Cognitive impairment indicated by a Short Portable Mental Status Questionnaire adjusted error score of \>5
  3. Has no family member who might assist in decision making or family member declines to participate.
  4. Is not accompanied to the clinic by family member.
  5. G.4. Family Exclusion Criteria

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  1. Declines to participate.
  2. Severe visual impairment that would limit ability to visualize instrument illustrations.
  3. Cognitive impairment indicated by a Short Portable Mental Status Questionnaire adjusted error score of \>5
D: Inclusion Criteria: Physicians

* Currently in clinical practice at participating institutions
* Oncologist that cares for patients with solid tumors
* Not planning to leave the practice during the next 6 months

Inclusion Criteria: Patients

* Currently a patient of an enrolled physician
* Age 21 years or older
* Diagnosis of advanced cancer
* Able to understand spoken English (study personnel will read materials to low literacy patients)

Inclusion Criteria: Caregivers

* Caregiver of a patient currently enrolled in the study
* Age 21 years or older
* Able to understand spoken English (study personnel will read materials to low literacy patients)

Exclusion Criteria: Physicians

* Non Physicians and physicians who are not oncologists
* Oncologists who exclusively care for patients with hematological malignancies
* Prior involvement in health-related coaching interventions

Exclusion Criteria: Patients

* Unable to complete orally-administered surveys in English
* Hospitalized or in hospice care at the time of recruitment
* Prior involvement in health-related coaching interventions
* Anticipating bone marrow transplantation or diagnosed with leukemia or lymphoma

Exclusion Criteria: Caregiver

Unable to complete orally-administered surveys in English

Answer: B