Video Images About Decisions for Ethical Outcomes in the Emergency Department (VIDEO-ED)

Study Overview
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Brief Summary
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A randomized controlled trial of a video decision aid in the Emergency Department Setting to improve advance care planning documentation.

Detailed Description
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A randomized controlled trial of a video decision aid in the Emergency Department setting shown to patients followed by a brief advance care planning discussion and then relay that discussion to the patient's primary care provider and/or admitting clinical team and look at rates of advance care planning documentation in the electronic health record over time. Primary outcome is advance care planning documentation in the EHR at 3 months.

Official Title
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Using the Emergency Department Visit to Promote Advance Care Planning

Conditions
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Emergencies

Intervention / Treatment
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* Behavioral: video decision aid
* Behavioral: control arm ACP information sheet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: anyone aged 65 and over or anyone aged over 50-64 with an indicator of serious illness Exclusion Criteria: non english or spanish speakers those with a POLST legally blind medically non stable requiring ICU level care

Ages Eligible for Study
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Minimum Age: 50 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
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: RCT
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Video<br>Video decision aid and advance care planning discussion | Behavioral: video decision aid<br>* advance care planning video decision aid<br>|
| Active Comparator: Control arm<br>Usual advance care planning services provided at the study site. | Behavioral: control arm ACP information sheet<br>* control arm ACP information sheet<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| EHR documentation of advance care planning | EHR documentation of advance care planning | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| patient reported conversations with health care providers and family | patient reported conversations with health care providers and family | at 3 and 6 months | 
| concordance between stated and documented preferences | concordance between stated and documented preferences | at 3 and 6 months | 
| ACP documentation in the EHR | ACP documentation in the EHR | at 6 months | 
| hospitalization | hospitalization | at 3 and 6 months | 
| differential intervention effects of the ACP video intervention on patient ACP documentation based on race and ethnicity | We will look at ACP documentation in the intervention and control arms to see if there are differential intervention effects based on race and ethnicity. We will look at the ACP documentation rate in Whites in both arms, and compare them to African Americans and Latinx populations. We will be able to see if the intervention had a greater or lesser effect on ACP rates in sub groups of our population by race and ethnicity. | at baseline, 3 and 6 months | 
| quality of clinician ACP communication using an ACP quality communication survey | quality of ACP communication using an ACP quality communication survey | quality of communication at the time of the survey interview (baseline), and then at 3 and 6 months | 
| place of death | place of death | at 3 and 6 months | 
| enrollment in hospice | enrollment in hospice | at 3 and 6 months | 
| ED visits | ED visits | at 3 and 6 months | 
| mortality | mortality | at 3 and 6 months | 
| ICU days | ICU days | at 3 and 6 months | 
| patient CPR and breathing machine preferences | we will ask the patient whether or not they want CPR attempted and whether they would wish to be placed on a breathing machine | at time of survey (baseline) and then after 3 and 6 months | 
| patient preferences for goals of care | We will ask patient if they wish to receive life prolonging care, limited care or comfort care. | at time of survey (baseline) and then after 3 and 6 months | 
| decisional certainty regarding decision making for ACP preferences | we will ask patients how certain they are about their decisions for the goals of care | at baseline survey interview | 
| patient knowledge of ACP | We will ask patients knowledge questions about their understanding of advance care planning | at baseline survey interview | 
| patient confidence in health care delivery that is aligned with patient preferences | We will ask patients how confident they are in that they will receive the type of medical care they wish in their health care system | at time of survey (baseline) and then after 3 and 6 months | 
| patient ACP engagement with ACP topics | We will ask patients how ready and engaged they are with the topic of advance care planning | at baseline survey interview |