Advance Care Planning in Cognitive Disorders Clinic

Study Overview
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Brief Summary
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Advance care planning among patients with cognitive disorders poses unique challenges to clinicians. To improve planning in patients with Alzheimer's disease and other dementias, the researchers suggest a routine, standardized approach to these conversations. The main outcome measure is the rate of entry of Advance Directive completion in the patient's Electronic Health Record (EHR). A control group of similar patients from another provider specializing in cognitive disorders will be used to tease out confounding variable effects.

Official Title
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Responses to a Standardized Approach to Advance Care Planning in Cognitive Disorders Clinic

Conditions
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Advance Care Planning

Intervention / Treatment
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* Other: Advance Care Planning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients having mild cognitive impairment (MCI) or very mild to mild dementia (CDR 0.5-1). Exclusion Criteria: Patients with moderate to severe dementia (CDR 2-3).

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 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: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention Group<br>Patients diagnosed with mild cognitive impairment, very mild dementia, or mild dementia, will receive the guided advance care planning conversations with the PI | Other: Advance Care Planning<br>* The provider will guide advance care planning conversations with patients identified with mild or moderate dementia during their third office visit, approximately three months after the first visit.<br>|
| No Intervention: Control Patients<br>Patients diagnosed with mild cognitive impairment, very mild dementia, or mild dementia, will not receive the guided advance care planning conversations with the PI | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in rate of advance directive completion during or following the visit |  | Baseline; Month 6; Month 12; Month 18 | 
| Change in the rate of completed advance directives that are uploaded to the patient's electronic medical record |  | Baseline; Month 6; Month 12; Month 18 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Hospital Anxiety and Depression Scale (HADS) | Scale consisting of 14 items (7 relating to anxiety; 7 to depression). Scores range from 0-21 (0-7 being normal; 08-10 being borderline abnormal; 11-21 being abnormal for anxiety and depression). | Baseline; Month 2; Month 3 | 
| Change in Beck Hopelessness Scale (BHS) | Scale consisting of 20 true-false items arrayed within three factors: Feelings about the future, loss of motivation, and future expectations. Scores range from 0-20 (0-3 as are considered within the normal range, 4-8 identify mild hopelessness, scores from 9-14 identify moderate hopelessness, and scores greater than 14 identify severe hopelessness). | Baseline; Month 2; Month 3 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Alzheimer's disease, Dementia