Feasibility Of An Advanced Care Decision Aid Among Patients And Physicians_Matlock
Condition: Palliative Care; Decision Making; Decision Support Techniques; Decision Support Systems, Clinical; Hospices
Study type: Interventional

Summary: 
      The investigators propose an evaluation of an end of life patient decision aid (EOL-PtDA)
      developed by the Foundation for Informed Medical Decision Making using the RE-AIM (Reach
      Effectiveness, Adoption, Implementation, and Maintenance) framework. To evaluate the Reach
      and Effectiveness, the investigators propose a pilot randomized clinical trial of the
      EOL-PtDA among patients on the inpatient palliative care service at University Hospital in
      Colorado. To evaluate barriers and facilitators of Adoption, Implementation, and Maintenance
      of the EOL-PtDA, we propose focus groups of non-palliative care physicians as we perceive
      these physicians to be the largest barrier to ultimate adoption of the EOL-PtDA. Additionally
      we propose a focus group of the palliative care physicians who participated in the
      implementation of this decision guide study to evaluate the feasibility of conducting a
      randomized control trial within a pall. care service and to evaluate the acceptability of
      this decision aid as it was implemented. The investigators also propose to conduct focus
      groups of normal, healthy clinic patients to determine the acceptability among that
      population. The End-of-Life decision aid is different from other decision aids. From the
      vantage point of decision quality, a major difference is that its primary focus is on helping
      patients clarify their values rather than gain knowledge. The results from this study will
      provide critical preliminary data to inform a randomized clinical trial and/or widespread
      implementation of the EOL-PtDA.

      Specific Aims/Research question(s):Aim 1: To determine the Reach and Effectiveness of an
      end-of-life patient decision aid by conducting a pilot randomized clinical trial in an
      inpatient palliative care service. Aim 2: To determine physicians' attitudes towards the
      end-of-life patient decision aid and to gain insights into potential barriers and
      facilitators to Adoption, Implementation, and Maintenance by conducting a qualitative study
      of non-palliative care, and separately, palliative care physicians. Aim 3: To determine
      healthy clinic patients' attitudes towards the end-of-life patient decision aid and to gain
      insight into its Reach and Effectiveness.
    

Detailed description: 
      The aims 2-3 of this study include focus groups for physicians (both palliative care and
      non-palliative care physicians, aim 2) as well as healthy clinic patients (aim 3). Since
      these two arms are not randomized, they are not reported here. For additional information on
      the protocol and findings, please contact the PI, Daniel.Matlock@ucdenver.edu or the study
      coordinator, Tarah.Keech@ucdenver.edu.
    

Intervention name(s): End-of-Life / Advanced Care Decision Aid; Active Comparator
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Patients assigned to the control group will receive usual care which includes a discussion of knowledge about their medical condition as well as their goals of care. Typically, this discussion includes one physician and one advanced practice nurse however there are occasions such as weekends and during clinic time where the consult will have only one palliative care team member. This consultation typically includes a discussion of advanced directives using the five wishes document.; TAU
Other intervention name(s): FIMDM; Looking Ahead: Choices for medical care when you're seriously ill
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: End of life decision making; End of life decision aid; Palliative care decision making; Palliative care decision aid; Advanced care planning; Decision Aid