Clinical trial NCT01362855: Advance Care Planning Evaluation in Hospitalized Elderly Patients
Official title: Advance Care Planning Evaluation in Hospitalized Elderly Patients: A Multicenter, Prospective Study
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Critical Illness
Chronic Obstructive Lung Disease
Congestive Heart Failure
Cirrhosis
Cancer
Keywords: Advance Care Planning
End of life
Knowledge translation
Goals of care
Advance directive
Living will
Lead sponsor: Clinical Evaluation Research Unit at Kingston General Hospital
Sponsor class: OTHER
Collaborators: name: Canadian Institutes of Health Research (CIHR)
First posted: 2011-05-30
Enrollment: 503
Sex: ALL
Minimum age (years): 55
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: OTHER
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: We will enroll patients who are at high risk of dying and/or their families (where available).

Brief summary: The purpose of the study is to inform decision-makers of the best strategies to implement advanced care planning (ACP).

An advanced care plan (ACP) is a verbal or written instruction describing what kind of care an individual would want (or not want)if they are no longer able speak for themselves to make health care decisions.

Detailed description: Advance Care Planning (ACP) may offer some assistance with reducing health care costs for older Canadians and yet, at the same time, improving quality of care. ACP is the process by which a person considers options about future health care decisions and identifies their wishes. ACP has been shown to increase the quality of life of dying patients, improve the experience of family members, and decrease health care costs.

There have been initiatives leading to the development and implementation of system-wide strategies to increase ACP, however there has been no evaluation of the effectiveness of these efforts from the perspective of patients and families. Many questions pertaining to barriers and facilitators to implementation and impact of ACP on outcomes in Canada remain.

The investigators propose to conduct a perspective audit of current practice related to ACP in elderly patients at high-risk for dying and their families. The investigators will determine the extent to which these patients and families have engaged in ACP, what barriers and facilitators they preceive, and how satisfied they are with communication and decision making at the end of life. Informed by a baseline evaluation of site strengths, weaknesses and barriers, the investigators propose to develop tailored interventions to enable participating sites to improve their success with ACP during the entire study period. By repeating the audit and feedback cycle annually, the investigators will enable sites to make continuous efforts to improve their performance and be able to evaluate the effect of our audit/feedback/tailored intervention strategy compared to baseline. Additionally, for those patients who have engaged in ACP activities, the investigators can compare their outcomes to those who have not.

The overall goal of this study is to inform decision-makers as the best strategies to implement advance care planning (ACP).

Eligibility criteria: Inclusion Criteria:

* 55 years or older with one or more of the following diagnoses:

  * Chronic obstructive lung disease - 2 of the 4 of: baseline PaCO2 of \> 45 torr, cor pulmonale; respiratory failure episode within the preceding year; forced expiratory volume in 1 sec \<0.5 L.
  * Congestive heart failure - New York Heart Association class IV symptoms and left ventricular ejection fraction \< 25%.
  * Cirrhosis - confirmed by imaging studies or documentation of esophageal varices and one of three conditions: a) hepatic coma, b) Child's class C liver disease, or c) Child's class B liver disease with gastrointestinal bleeding.
  * Cancer - metastatic cancer or stage IV lymphoma.
  * End-stage dementia (inability to perform all ADLs, mutism or minimal verbal output secondary to dementia, bed-bound state prior to acute illness) OR
* Any patient 80 years of age or older admitted to hospital from the community because of an acute medical or surgical condition.

Exclusion Criteria:

* Non-English speaking patient/family member
* Patient with cognitive impairment

Primary outcomes:
measure: Extent of Implementation of ACP
timeFrame: Year 3
Secondary outcomes:
measure: Effect of an audit and feedback process plus tailored interventions ACP
timeFrame: Year 3
measure: Impact of ACP on patient/family satisfaction
timeFrame: Year 3
measure: ACP components associated with overall satisfaction
timeFrame: Year 3
measure: Comparison of sites with low vs high system level implementation of ACP on satisfaction
timeFrame: Year 3
Other outcomes:
Locations:
city: Calgary
country: Canada
facility: Peter Lougheed Hospital
state: Alberta
city: Calgary
country: Canada
facility: Foothills Medical Centre
state: Alberta
city: Edmonton
country: Canada
facility: Royal Alexandra Hospital
state: Alberta
city: New Westminster
country: Canada
facility: Royal Columbian Hospital
state: British Columbia
city: Vancouver
country: Canada
facility: Vancouver Hospital
state: British Columbia
city: Vancouver
country: Canada
facility: St Paul's Hospital
state: British Columbia
city: Vancouver
country: Canada
facility: St.Paul's Hospital
state: British Columbia
city: Hamilton
country: Canada
facility: Hamilton General Hospital
state: Ontario
city: Kingston
country: Canada
facility: Kingston General Hospital
state: Ontario
Study officials:
affiliation: Queen's University
name: Daren K Heyland, MD, MSc
role: PRINCIPAL_INVESTIGATOR
References:
citation: Heyland DK, Heyland R, Dodek P, You JJ, Sinuff T, Hiebert T, Jiang X, Day AG; ACCEPT Study Team and the Canadian Researchers at the End of Life Network (CARENET). Discordance between patients' stated values and treatment preferences for end-of-life care: results of a multicentre survey. BMJ Support Palliat Care. 2017 Sep;7(3):292-299. doi: 10.1136/bmjspcare-2015-001056. Epub 2016 Oct 6.
citation: Heyland DK, Dodek P, You JJ, Sinuff T, Hiebert T, Tayler C, Jiang X, Simon J, Downar J; ACCEPT Study Team and the Canadian Researchers at the End of Life Network (CARENET). Validation of quality indicators for end-of-life communication: results of a multicentre survey. CMAJ. 2017 Jul 31;189(30):E980-E989. doi: 10.1503/cmaj.160515.