Implementing Advance Care Planning Conversation Tools in Family Practice

Study Overview
=================
Brief Summary
-----------------
This study evaluates the use of advance care planning conversation tools with patients attending their family doctor's office. Patients complete tools about their values and wishes, and a health care provider uses a structured discussion tool to talk about the patient's health condition and future wishes. The patient's family member/substitute decision-maker is encouraged to attend and be part of the discussions.

Detailed Description
-----------------
Structured tools are helpful for advance care planning. Tools have been developed to help with advance care planning because it is a process which has multiple steps and people involved. This study will help health care teams in primary care learn to use the tools with frail or older seriously ill patients and will evaluate the perceptions of patients, family members and health care providers, as well as the impact of having the discussions on subsequent health care interactions the patient has. Patients complete tools about their values and wishes, and a health care provider uses a structured discussion tool to talk about the patient's health condition and future wishes. The patient's family member/substitute decision-maker is encouraged to attend and be part of the discussions.

Official Title
-----------------
Implementing Advance Care Planning Conversation Tools in Family Practice

Conditions
-----------------
Frail Elderly Syndrome, Chronic Disease

Intervention / Treatment
-----------------
* Behavioral: Advance care planning tools


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: age 60 or older chronic condition that may reduce life expectancy as per physician's clinical judgement able to communicate verbally in English and read English Exclusion Criteria: unable to communicate verbally in English unable to read English cognitively unable to give informed consent (e.g. memory problems) as judged by referring physician or research assistant

Ages Eligible for Study
-----------------
Minimum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Interventional Model Description: Single group before-after
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Advance care planning tools<br>Advance care planning education and structured conversation using tools | Behavioral: Advance care planning tools<br>* Structured conversations between patients/substitute decision-maker and clinician based on education about advance care planning using locally relevant booklet/website, values clarification tool for patient engagement, clinician use of the Serious Illness Conversation Guide<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Advance care planning engagement | Survey measuring domains of engagement in advance care planning | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Advance care planning engagement-substitute decision maker | survey measuring substitute decision maker domains of engagement in advance care planning | 12 weeks | 
| Patient experience | survey of patient experience with intervention | 12 weeks | 
| Patient perceived impact on health care | qualitative interviews of patients asking perceived impact of intervention on later health care use | 6-9 months |