ACP Video Intervention for Patients With Life-Limiting Illness

Study Overview
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Brief Summary
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The goal of this research is to increase patients' knowledge about advance care planning (ACP) discussions and hospice care for patients with serious illness receiving home-based care.

Detailed Description
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ACP is a process that allows patients to communicate their wishes and preferences or medical care, when they are seriously ill, to their medical providers. The study investigators would like to assess whether a home-ACP video can improve patient-clinician communication about patients wishes for their medical care and lead to more patient-centered care. This study is a randomized clinical trial of a Home-ACP intervention among 500 adult patients with serious illness receiving medical care at home with the Clover Health House Calls Program. Study participants will be assigned to one of two groups. In one group, participants will continue to receive usual care with their home-based care team. In the second group, participants will continue to receive their usual care with their home-based care team and also view an ACP video that helps them understand ACP and provides education about ACP and hospice care.

Official Title
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Randomized Trial of a Home-Advance Care Planning Video Intervention for Patients With Life-Limiting Illness

Conditions
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Health Care Utilization, End Stage Disease

Intervention / Treatment
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* Behavioral: Home ACP Video


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 21 or over Have a one-year prognosis or less as determined by Clover Health's validated algorithm Speak either English or one of the other 25 languages in which the video intervention is available Exclusion Criteria: Visually impaired beyond 20/200 corrected Acute psychiatric illness or other comorbid condition that impairs cognitive ability to participate in advance care planning discussion as determined by the primary House Call Provider.

Ages Eligible for Study
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Minimum Age: 21 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 |
| --- | --- |
| No Intervention: Usual Care<br>Usual care entails receiving usual medical care by the home-based care team. | |
| Experimental: Video intervention<br>In addition to usual care, the intervention will entail having a visit by a trained study clinician to provide access to the ACP video. The study clinician will discuss the content of the video and answer any questions. | Behavioral: Home ACP Video<br>* A video focused on Advance Care Planning and Hospice for patients with serious illness<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospice utilization | Compare the use of hospice (yes vs. no) between the study groups | up to one year follow-up or death | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospice length of stay | Compare hospice length-of-stay between the study groups | up to one year follow-up or death | 
| Rates of documented resuscitation preferences in the Electronic Health Record | Compare documented resuscitation preferences in the Electronic Health Record between the two groups | up to one year follow-up or death | 
| Rates of Advance Care Planning documentation in the Electronic Health Record | Compare advance care planning documentation in the Electronic Health Record between the two groups | up to one year follow-up or death | 
| Patient knowledge about Advance Care Planning | Compare patient's knowledge about advance care planning using a 5-item knowledge questionnaire (range 0-5), higher score indicate more knowledge | Up to two days following the intervention visit | 
| Patient reported confidence in care | Compare patient's reported confidence in their medical care using a single Likert response question between the two study groups. Score range from 0-4. Higher scores indicate higher confidence in care | up to two days following the intervention visit | 
| Patient reported satisfaction with clinician communication | Compare patient satisfaction with their communication with their clinician using the CAHPS subscale. Score range 0-20. Higher score indicate better satisfaction with communication | up to two days following the intervention visit | 
| Patient reported decisional satisfaction | Compare patient reported decisional satisfaction between the study groups using the Satisfaction with Decision Scale. Scale range from 6-30. Higher scores indicate higher satisfaction with decision | up to two days following the intervention visit | 
| Patient reported decisional certainty | Compare patient reported decisional certainty between the two groups using the Decision Conflict Scale. Score ranges from 0 to 100. Higher scores indicate higher decisional conflict | up to two days following the intervention visit |