An Inpatient Advance Care Planning Intervention for Older Patients With Hematologic Malignancies

Study Overview
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Brief Summary
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This is a pilot study to assess the preliminary efficacy of an inpatient advance care planning intervention on outcomes in older patients with hematologic malignancies

Detailed Description
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Older adults with hematologic malignancies receive more aggressive inpatient care at the end of life compared to patients with solid tumors. Advance care planning may promote early serious illness conversations for patients with hematologic malignancies, leading to less aggressive healthcare utilization at the end of life. This pilot aims to assess the preliminary efficacy of an inpatient advance care planning intervention on outcomes in older patients with hematologic malignancies.

Official Title
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An Inpatient Advance Care Planning Intervention for Older Patients With Hematologic Malignancies

Conditions
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Hematologic Malignancies

Intervention / Treatment
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* Behavioral: Inpatient serious illness care program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥60 years A diagnosis of hematologic malignancy [including but not limited to acute leukemia, myeloid malignancies (e.g., atypical CML, MDS/MPN overlap syndromes, CMML), multiple myeloma, lymphoma, or any other hematologic malignancies based on the primary oncologist's judgment] Able to provide informed consent Being managed in the inpatient setting English-speaking Exclusion Criteria: • None

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Interventional Model Description: The intervention used in this study is an inpatient advance care planning intervention. We will adapt the Serious Illness Care Program, an evidence-based intervention that promotes serious illness conversation between patients and clinicians, to be used by advance practice providers and hematology/oncology fellow physicians in the inpatient setting.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental<br>Patients will participate in an inpatient advance care planning intervention. | Behavioral: Inpatient serious illness care program<br>* Inpatient advance care planning intervention that will be delivered by advanced care practitioners or hematology/oncology fellow physicians. The intervention will be an adapted version of the serious illness care program.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Completion of advance directives | Data on completion of advance directives will be collected via the electronic medical record. This will include explicit statement of the patient's medical preferences for end of life care in a note, scanned medical order for life sustaining treatment (MOLST) form that was completed with their clinician, and/or scanned healthcare proxy form that was completed with their clinician. This will be expressed as a percentage. | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| End of life quality indicators | End of life quality indicators will be extracted from the electronic medical record. These metrics will include hospice enrollment, palliative care referral, chemotherapy administration within the last 2 weeks of life, emergency department visits in the last 30 days of life, intensive care unit admissions in the last 30 days of life, hospitalizations in the last 30 days of life, use of life-sustaining treatments in the last 30 days of life, transfusions in the last 7 days of life, and place of death. These will be expressed as percentages. | Up to 5 years following their participation in the study or death | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Advance Care Planning Intervention, Serious Illness Conversation, Hematologic Malignancies