Motivational Interview Intervention to Help Patients Formulate Their Goals for Medical Care in the Emergency Department

Study Overview
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Brief Summary
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Test the acceptability and feasibility of a brief motivational interview intervention to facilitate advance care planning (ACP) conversations for older adults with serious co-morbid illness being discharged from the emergency department (ED). The investigators will interview the participants to understand their perception of the intervention and collect patient-reported outcomes data after leaving the ED.

Detailed Description
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This study is designed to engage seriously ill older adults in conversations about their goals of care. Our intervention is intended to help these patients understand the significance of ED visits in the course of their illnesses.

Official Title
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A Pilot Study to Test the Acceptability and Feasibility of Brief Motivational Interview Intervention to Help Patients Formulate Their Goals for Medical Care in the Emergency Department

Conditions
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Emergency Service, Hospital, Motivational Interviewing, Advance Care Planning

Intervention / Treatment
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* Behavioral: Brief motivational interview intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥65 years of age English-speaking Capacity to consent AND ≥1 Serious illness (New York Heart Association stage 3 or 4 heart failure, oxygen-dependent chronic obstructive lung disease, chronic kidney disease on dialysis, and metastatic cancer.) OR determined by the emergency department provider that the patient has a high likelihood of death in the next 12 months (I would not be surprised if this patient died in the next 12 months.). Exclusion Criteria: Acute physical or emotional distress Determined by emergency department provider not to be appropriate Clearly documented goals for medical care already exists (e.g. medical order for life sustaining treatment - MOLST). Already enrolled in this study

Ages Eligible for Study
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Minimum Age: 65 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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention Arm<br>This is a single arm study with all enrolled patients receiving the same brief motivational interview intervention. | Behavioral: Brief motivational interview intervention<br>* A brief (<7minutes) interview by an emergency department clinician to empower patients to formulate and communicate their goals for medical care with patients' outpatient clinicians.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients Who Found the Intervention Acceptable and Provided Suggestions for Improvement | The investigator will measure quantitatively and qualitatively whether patients found this intervention acceptable and provided suggestions for its improvement. | Immediately following the intervention in the emergency department. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptability of the Intervention by Administering Clinicians. | The investigators will ask the emergency department clinicians who administered the intervention to report the intervention acceptability using a Likert scale survey. | Immediately following the intervention in the emergency department. | 
| Patient's Quality of Life | The investigators will measure patient's quality of life using a validated survey measure (Quality of life at the end of life, QUAL-E, Steinhauser et al. 2004) at baseline and after the intervention. QUAL-E consists of 25-items and measures 4 domains (symptom impact, relationship with the healthcare provider, preparation for the end of life, and life completion). Each item is in a 5-point Likert scale ranging from (1 Not at all to 5 Completely), and lower scores indicate better outcomes for all domains except for the preparation for the end of life domain and life completion domain where higher scores indicate better outcomes. The mean composite score is compared between baseline and 1 month after the intervention. | At baseline (in-person) and 1 month after (over the phone) the intervention. | 
| Advance Care Planning Engagement Behavior | The investigators will measure patient's behaviors and actions for completing advance care planning using a validated survey measure (advance care planning engagement survey, Sudore et al 2017) at baseline and after the intervention. The measure is a 4-item survey measuring actions and behaviors of advance care planning. The additive composite score is calculated and ranges from 1 (least engagement) to 5 (most engagement). | At baseline (in-person) and 1 month after (over the phone) the intervention. | 
| Patient Empowerment | The investigators will measure patient empowerment by using a validated survey measure (Patient Activation Measure, PAM™) at baseline and after the intervention. | At baseline (in-person) and 1 month after (over the phone) the intervention. | 
| Patient Distress | The investigators will measure patient anxiety/distress regarding a particular event (in this case, our intervention) by using a validated survey measure (Impact of Event Scale - Revised, IES-R, Weiss 1996) within a week after the intervention. IES-R is a 22-item, 5-point Likert scale measure (ranging from 0 Not at all to 4 Extremely). Results consist of the mean rating for the total score and raw scores for three subscales: The Avoidance Scale, Intrusion Scale, and the Hyperarousal Scale. The scores give an indication of the level of impairment from post traumatic stress, where: 0 = No symptoms 1 = Few symptoms 2 = Moderate symptoms 3 = A High level of symptoms 4 = An Extremely high level of symptoms | Within 7 days after the intervention. |