Clinical trial NCT05909189: LEADing Dementia End-of-Life Planning Conversations
Official title: LEADing Dementia End-of-Life Planning Conversations
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Alzheimer Disease
Mild Cognitive Impairment
Keywords: advance care planning
caregiving
decision-making
Lead sponsor: University of Utah
Sponsor class: OTHER
Collaborators: name: National Institute on Aging (NIA)
First posted: 2023-06-18
Enrollment: 120
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: The LEAD Intervention is a web-baed platform that integrates the LEAD Guide with self-paced educational modules that guide care recipient-care partner pairs through conversations and the process of dementia-focused advance care planning. The aims of this study are: 1. To describe the acceptability, usability, and feasibility of the LEAD Intervention. Methods: Conduct a process evaluation using survey-based outcome assessments and qualitative analysis of participant-recorded advance care planning conversation(s)to identify facilitators and/or barriers to intervention participation. 2. To assess the initial efficacy of the LEAD Intervention on the primary outcome and secondary outcomes as perceived by both the care recipient and the care partner. 3. To examine advance care planning congruence as a mechanism of action for the LEAD Intervention.
Primary purpose: SUPPORTIVE_CARE

Brief summary: Advance care planning is important for all adults, but perhaps even more so for the 5.7 million persons with Alzheimer's disease or related dementia (ADRD), due to the progressive and protracted cognitive deterioration associated with the disease process. In the context of ADRD, medical decision-making at the end of life is typically left to one's care partner, who often does not have the knowledge or confidence in their ability to make such decisions. This study will refine and evaluate a web-based platform, called the LEAD Intervention (Life-Planning in Early Alzheimer's and other Dementias), which is designed to help persons in the preclinical or early stage of ADRD engage in conversations about, document, and share their end-of-life values and preferences with a care partner, extended family members, and health care providers.

Detailed description: Advance care planning is the process that allows individuals to express their future healthcare values and preferences so that these wishes can be enacted in the event that they become incapacitated and unable to participate in their own healthcare decisions. In the case of Alzheimer's disease or related dementia (ADRD), the person with dementia (care recipient), almost inevitably loses decisional capacity toward the end of life, given the progressive decline in cognitive functioning that accompanies the disease over time. The care partners to persons with dementia, most often family members such as spouse/partners and adult children, are therefore tasked with making end-of-life decisions on behalf of the care recipient with ADRD. These care partners are not always well-informed of the care recipient's end-of-life values and preferences and therefore may not feel confident in their ability to make decisions regarding care and treatment at the end-of-life, resulting in unnecessary, futile, and often unwanted medical treatments and interventions. Oftentimes, families do not want to engage in these challenging conversations and wait too long, whereby the care recipient with ADRD no longer has the decisional ability to participate in the advance care planning process. We developed "The LEAD Guide" (Life-Planning in Early Alzheimer's and other Dementias), as a tool to help persons with preclinical awareness of ADRD risk and those with early-stage cognitive impairment to begin these important conversations with a care partner. In this NIH Stage-1 behavioral intervention study we will refine the LEAD Intervention based on our pilot work (Stage 1A) and then evaluate the usability, acceptability, feasibility, and initial efficacy of the LEAD Intervention (Stage 1B). We will recruit a diverse sample of 60 community-dwelling ADRD pairs, defined as a care recipient in the preclinical or early stage of ADRD, plus their current or anticipated care partner (i.e., spouse/partner or adult child). Results are expected to show that the LEAD Intervention can improve outcomes related to decision-making self-efficacy through greater advance care planning congruence and improve subjective well-being, anxiety, and relationship quality as perceived and reported by both the care recipient and the care partner. Results from this study have the potential to guide and accelerate the implementation of the LEAD Intervention in community and healthcare practice, where a dementia-focused advance care process is needed.

Eligibility criteria: Inclusion Criteria:

* Care Recipient (CR) is age 50+
* CR Is interested in having conversations about and documenting wishes for future end-of-life care
* CR has noticed changes in memory or thinking skills indicative of preclinical or early stage of AD, OR
* CR has been diagnosed with mild cognitive impairment, Alzheimer's disease, or another type of dementia and in the preclinical or early stage
* Care Partner (CP) is age 18+
* CP is a Spouse/partner, family member, or close friend of CR

Exclusion Criteria:

* Has moderate to severe symptoms of dementia

Primary outcomes:
measure: Decision-Making Self-Efficacy
timeFrame: Week 20
Secondary outcomes:
measure: Relationship Quality
timeFrame: Week 20
measure: Anxiety
timeFrame: Week 20
measure: Subjective well-being
timeFrame: Week 20
Other outcomes:
Locations:
city: Salt Lake City
country: United States
facility: University of Utah College of Nursing
state: Utah
Study officials:
affiliation: University of Utah
name: Kara Dassel, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Dassel KB, Utz R, Supiano K, McGee N, Latimer S. The Influence of Hypothetical Death Scenarios on Multidimensional End-of-Life Care Preferences. Am J Hosp Palliat Care. 2018 Jan;35(1):52-59. doi: 10.1177/1049909116680990. Epub 2016 Dec 17.
citation: Supiano KP, McGee N, Dassel KB, Utz R. A Comparison of the Influence of Anticipated Death Trajectory and Personal Values on End-of-Life Care Preferences: A Qualitative Analysis. Clin Gerontol. 2019 May-Jun;42(3):247-258. doi: 10.1080/07317115.2017.1365796. Epub 2017 Oct 9.
citation: Dassel K, Utz R, Supiano K, Bybee S, Iacob E. Development of a Dementia-Focused End-of-Life Planning Tool: The LEAD Guide (Life-Planning in Early Alzheimer's and Dementia). Innov Aging. 2019 Aug 2;3(3):igz024. doi: 10.1093/geroni/igz024. eCollection 2019 Jul.