Clinical trial NCT03208530: Motivational Interview Intervention to Help Patients Formulate Their Goals for Medical Care in the Emergency Department
Official title: 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
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Emergency Service, Hospital
Motivational Interviewing
Advance Care Planning
Lead sponsor: Brigham and Women's Hospital
Sponsor class: OTHER
First posted: 2017-07-05
Enrollment: 75
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Number of Patients Who Found the Intervention Acceptable and Provided Suggestions for Improvement
timeFrame: Immediately following the intervention in the emergency department.
Secondary outcomes:
measure: Acceptability of the Intervention by Administering Clinicians.
timeFrame: Immediately following the intervention in the emergency department.
measure: Patient's Quality of Life
timeFrame: At baseline (in-person) and 1 month after (over the phone) the intervention.
measure: Advance Care Planning Engagement Behavior
timeFrame: At baseline (in-person) and 1 month after (over the phone) the intervention.
measure: Patient Empowerment
timeFrame: At baseline (in-person) and 1 month after (over the phone) the intervention.
measure: Patient Distress
timeFrame: Within 7 days after the intervention.
Other outcomes:
Locations:
city: Boston
country: United States
facility: Brigham and Women's Hospital
state: Massachusetts
Study officials:
affiliation: Brigham and Women's Hospital
name: Kei Ouchi, MD, MPH
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ouchi K, George N, Schuur JD, Aaronson EL, Lindvall C, Bernstein E, Sudore RL, Schonberg MA, Block SD, Tulsky JA. Goals-of-Care Conversations for Older Adults With Serious Illness in the Emergency Department: Challenges and Opportunities. Ann Emerg Med. 2019 Aug;74(2):276-284. doi: 10.1016/j.annemergmed.2019.01.003. Epub 2019 Feb 13.