Project to Improve Communication About Serious Illness - Pilot Study

Study Overview
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Brief Summary
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This two-year pilot study will test whether a one-page Jumpstart Form will affect goals-of-care discussions in the hospital. This form will be provided to clinicians and will include patient-specific information about preferences for goals-of-care communication and for care, as well as tips to improve this communication. Jumpstart forms will also be provided to patients or, if they are unable to communicate, their surrogates/family members. The information on the form will be obtained from questionnaires. The form is tailored to help patients and surrogates talk with clinicians about goals of care. This study is based on a successful application of Jumpstart Form in the outpatient clinic setting.

Official Title
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Using the Electronic Health Record to Identify and Promote Goals-of-Care Communication

Conditions
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Malignant Neoplasm, Leukemia, Lymphocytic, Chronic, B-Cell, Lung Disease Chronic, Congestive Heart Failure, Liver Failures, Chronic, Renal Insufficiency, Chronic, Dementia, Diabetes Complications, Peripheral Vascular Disease, Frail Elderly

Intervention / Treatment
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* Behavioral: Jumpstart Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria, Patients: meeting criteria for serious illness (encompassing multiple acute and chronic illnesses) including: those used by the Dartmouth Atlas to study end-of-life care in the US: malignant cancer/leukemia, chronic pulmonary disease, coronary artery disease, congestive heart failure, chronic liver disease, chronic renal disease, dementia, diabetes with end-organ damage, and peripheral vascular disease. patients over age 65 with markers of frailty: albumin level <3.0 within 48 hours of admission and weight loss of ≥10 pounds in the past year. hospitalized patients over age 80. English-speaking Exclusion Criteria, Patients: unable to complete informed consent procedures and do not have a legal next of kin restricted information status (e.g. prisoners) pregnant Inclusion Criteria, Surrogates: involved in the care of an eligible patient as the legal next-of-kin English-speaking Exclusion Criteria, Surrogates: unable to complete informed consent procedures

Ages Eligible for Study
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Minimum Age: 18 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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Jumpstart Intervention<br> | Behavioral: Jumpstart Intervention<br>* The intervention has 4 steps: use electronic medical record (EHR) to identify seriously ill, hospitalized patients with no documentation of a goals-of-care (GOC) discussion during their current admission; the enrolled patient or his/her surrogate completes a survey assessing preferences for discussions about GOC, barriers to having such discussions, and current GOC which is used to create a Jumpstart form designed to prompt and guide a GOC discussion between the patient or surrogate and the clinicians caring for the patient; use natural language processing/machine learning (NLP/ML) approach to identify GOC discussions or advance directives in the EHR that occurred prior to admission and include this information on the Jumpstart form; and, deliver the Jumpstart form to the primary clinician team. The patient or surrogate is also provided with a version of the form.<br>|
| No Intervention: Usual Care<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Documentation of goals of care | Presence or absence of documentation of goals of care discussions in the patient's electronic health record during the current hospitalization | At hospital discharge, an average of 2 weeks |