Clinical trial NCT06129149: The R4R Advance Care Planning Pilot Study
Official title: Resources for Resiliency (R4R) Advance Care Planning: A Pilot Study to Test a Trauma-Informed Care-adapted Advance Care Planning Intervention Among Affordable Housing Residents in Nashville
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Advance Care Planning
Keywords: advance care planning
affordable housing
housing insecurity
social determinants of health
trauma-informed care
qualitative research
implementation science
Lead sponsor: Vanderbilt University
Sponsor class: OTHER
First posted: 2023-11-13
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: OTHER

Brief summary: Affordable housing residents continue to experience multi-faceted insecurity and advance care planning (ACP) challenges even after obtaining secure housing, resulting in significant inequities in quality of care during times of cognitive incapacity. To promote proactive planning for affordable housing residents, this proposal is for a pilot study to test a novel trauma-informed care adapted advance care planning intervention with the following aims: to test initial efficacy of the intervention on ACP outcomes (Aim 1) and determine resident perceptions of intervention acceptability, appropriateness, and feasibility and perceived implementation barriers and facilitators (Aim 2). These data will support the development of a larger scale study of ACP interventions within a resiliency-based hub model to comprehensively support whole-person care and proactive planning for times of cognitive incapacity.

Detailed description: Long-term objectives and goals. Vanderbilt University School of Nursing (VUSN) and Urban Housing Solutions (UHS) - the second largest provider of affordable housing in Nashville - are partners with the long-term goal of reducing health disparities among medically-underserved UHS residents in Nashville. This partnership is developing resiliency hubs that will provide essential services and support within a communal setting at the housing facility. Previous literature and data findings support that similar populations to this community lack information about and access to advance care planning (ACP), which specifies their healthcare wishes during cognitive incapacitation or end-of-life, and nationwide research shows significant disparities regarding ACP participation among low-income populations. The short-term goal of the proposed work is to pilot test a Hybrid type 1, single-arm, pre-post intervention to assess the initial efficacy and implementation outcomes of a trauma-informed care (TIC)-adapted ACP intervention to improve learning and communication for times of decisional incapacity among UHS residents, within the context of a resiliency hub model. This is a necessary first step for developing a long-term research portfolio dedicated to addressing ACP disparities and promoting equitable end-of-life planning among low-income, medically-underserved populations.

Eligibility criteria: Inclusion Criteria:

* an adult (18+) residing in an affordable housing unit that does not have a completed advance directive

Exclusion Criteria:

* inability to provide informed consent or participate in the intervention due to cognitive, auditory, visual impairment or non-English language barrier

Primary outcomes:
measure: Advance Care Planning Values/Beliefs
timeFrame: Baseline to 30 days
measure: Advance Care Planning Processes
timeFrame: Baseline to 30 days
measure: Advance Care Planning Actions
timeFrame: Baseline to 30 days
measure: Implementation Acceptability
timeFrame: 30-day post-intervention follow-up (Visit 3)
measure: Implementation Appropriateness
timeFrame: 30-day post-intervention follow-up (Visit 3)
measure: Implementation Feasability
timeFrame: 30-day post-intervention follow-up (Visit 3)
Secondary outcomes:
Other outcomes:
Locations:
city: Nashville
country: United States
facility: Urban Housing Solutions
state: Tennessee
Study officials:
affiliation: Vanderbilt University
name: Kate Clouse, PhD, MPH
role: PRINCIPAL_INVESTIGATOR
affiliation: Vanderbilt University
name: Christian Ketel, DNP, RN, FNAP
role: PRINCIPAL_INVESTIGATOR
References: