Improving PCP Advance Care Planning for People With ADRD
NCT Number: NCT06565169
Acronym: AD-ACP
Status: NOT_YET_RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Alzheimer Disease|Dementia|Alzheimer's Disease (Incl Subtypes)|Aging
Interventions: BEHAVIORAL: Primary Care Team Advance Care Planning With People with Alzheimer's Disease or a Related Dementia Training|BEHAVIORAL: Care as Usual
Sponsor: University of Pittsburgh
Collaborators: University of North Carolina, Chapel Hill|National Institute on Aging (NIA)
Sex: ALL
Age: ADULT, OLDER_ADULT
Enrollment: 120
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: DOUBLE (INVESTIGATOR, OUTCOMES_ASSESSOR)|Primary Purpose: SUPPORTIVE_CARE
Start Date: 2024-09-01
Completion Date: 2027-05-31
Locations: University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, 27599, United States

Summary:
This study will test the Dementia Advance Care Planning (AD ACP) Toolkit intervention to usual care in facilitating goals of care (GOC) discussions between People Living with Dementia (PLwD) and primary care team members over an 18-month period. The primary outcome is to assess the frequency and quality of GOC discussions with PLwD. Secondary outcomes include the identification of preferred surrogates, assessment of decisional capacity, and the completion of portable ACP orders. This randomized clinical trial aims to determine if the AD ACP Toolkit can enhance ACP practices and improve care planning outcomes for PLwD compared to the standard care approach.

Primary Outcome Measures: Goals of Care Discussions, Presence of a documented Goals of Care (GOC) discussion between the primary care team member and the Person Living with Dementia (PLwD) or their surrogate decision-maker. Medical record documentation of discussion must include a) communication about dementia stage or prognosis AND b) decision-making for at least one major treatment: CPR/mechanical ventilation, hospitalization, treatments for infections, artificial/feeding/hydration, OR hospice., 18 months
Secondary Outcome Measures: Surrogate Decision-Maker, Choice of a surrogate decision-maker for the PLwD documented in the medical record., 18 months|Decision-Making Capacity, Assessment and report of decision-making capacity for the PLwD documented in the medical record., 18 months|Portable Advance Care Planning (ACP) Orders, Completion of portable ACP orders using a state-approved DNR or POLST form documented in the medical record., 18 months|Prognosis Discussion, Discussion of prognosis or future medical complications of Alzheimer's Disease/Alzheimer's Disease and Related Dementias (AD/ADRD) between the primary care team member and the PLwD or their surrogate decision-maker documented in the medical record., 18 months|Hospital Transfers, Number of emergency room visits and hospital admissions., 30 months|Adoption, The percentage of active users at each clinic who have completed at least one training of either type, 30 months|Length-of-Stay, Duration of hospitalizations from day of admission to day of discharge., 30 months|Palliative Care Referral, Percent of PLwD with a referral order to Palliative Care in the medical record., 30 months|Hospice Referral, Percent of PLwD with a referral order to Hospice in the medical record., 30 months|Goal-concordant care, Number of documented code status and health care proxy in the medical records, 30 months|Acceptability, Scores of Organizational Readiness to Implementing Change (ORIC) - range 12-60 with higher scores indicating greater organizational readiness, 6 months after provider training|Appropriateness, Scores of Intervention Appropriateness Measure (IAM) - range 4-20 with higher scores indicating greater appropriateness, 30 months|Feasibility, Scores of Feasibility of Intervention Measure (FIM) - range 4-20 with higher scores indicating greater feasibility, 30 months|Fidelity, Scores of primary care team members on post-intervention quizzes, participation in clinic-level and primary care team member-level ACP audit-and-feedback, refresher sessions and in-services, periodic coaching from the research team., 30 months