A Portal-based Advance Care Planning Intervention Among Community-Dwelling Persons Living With Cognitive Impairment
NCT Number: NCT06509373
Acronym: Portal-Voice
Status: RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Advanced Care Planning
Interventions: BEHAVIORAL: Advance Care Planning Tool - ACPVoice|BEHAVIORAL: Standard of Care for Advance Care Planning
Sponsor: Wake Forest University Health Sciences
Collaborators: National Institute on Aging (NIA)
Sex: ALL
Age: OLDER_ADULT
Enrollment: 300
Study Design: Allocation: NON_RANDOMIZED|Intervention Model: SINGLE_GROUP|Masking: NONE|Primary Purpose: HEALTH_SERVICES_RESEARCH
Start Date: 2024-08-19
Completion Date: 2025-04
Locations: Wake Forest University Health Sciences, Winston-Salem, North Carolina, 27157, United States

Summary:
The purpose of this research is to examine the feasibility of using a patient portal based advance care planning (ACP) tool to improve ACP discussions and documentation in persons living with cognitive impairment in outpatient primary care.

Primary Outcome Measures: Reach/Engagement, Percentage of participants who open the advance care planning tool (ACPVoice) mychart message, 6 months post intervention|Intervention Completion, Percentage of participants who were sent the ACPVoice mychart message that complete the ACPVoice tool., 6 months post intervention
Secondary Outcome Measures: Advance Care Planning Documentation Rates by Primary Care Providers, Documentation of advance care planning within the electronic health record by primary care provider., 12 months pre intervention|Advance Care Planning Documentation Rates by Primary Care Providers, Documentation of advance care planning within the electronic health record by primary care provider., 6 months post intervention|Advance Care Planning Billing Code Usage, Advance care planning billing codes usages will be recorded., 12 months pre intervention|Advance Care Planning Billing Code Usage, Advance care planning billing codes usages will be recorded., 6 months post intervention|Documented Designated Surrogate Decision Maker, Measured by number of designated surrogate decision makers documented in the electronic health record., 12 months pre intervention|Documented Designated Surrogate Decision Maker, Measured by number of designated surrogate decision makers documented in the electronic health record., 6 months post intervention
Other Outcome Measures: Barrier to Adoption, Data will be collected via qualitative interviews., 6 months during the implementation period and up to 6 months post the implementation period|Quality of Advance Care Planning Documentation, High-quality advance care planning documentation will be defined as addressing ≥4 of the 8 core components with 1 point assigned for each of the following questions related to: health-related goals, what matters most/most important in their life, health-related worries/concerns, named surrogate decision-maker, how much information they would like to know, unacceptable states at the end-of-life, goals if their health was to worsen, and questions about advance care planning forms. Score of 0-8 with 0 indicating no advance care planning questions answered to 8 indicating eight core advance care planning questions answered., 6 months during the implementation period and up to 6 months post the implementation period|Participant Confidence related to PCP knowing what is important to them, Data will be collected via a RedCap survey asking 5 questions: i. How confident are you your primary care clinician/team knows what is important to you?, ii. How confident are you that what is important to you will determine the medical care you receive in the future? , iii. To what extent did completing this care planning tool increase or decrease your sense of control over medical decisions?, iv. Before completing the care planning tool, did your primary care clinician/team ask what is important to you? , and v. After completing the care planning tool, did your primary care clinician/team ask what is important to you? ., 6 months during the implementation period and up to 6 months post the implementation period|Feeling Heard and Understood, Data will be assessed via a RedCap survey with 4 questions: I felt heard and understood by this provider and team, I felt this provider and team put my best interests first when making recommendations about my care, I felt this provider and team saw me as a person, not just someone with a medical problem, I felt this provider and team understood what is important to me in my life., 6 months during the implementation period and up to 6 months post the implementation period|Digital Health Literacy, Data will be measured using the Brief Digital Health Care Literacy Scale., 6 months during the implementation period and up to 6 months post the implementation period|Telephone Advance Care Planning Completion Rates, Defined as the number of patients who complete the advance care planning tool (ACPVoice) over the telephone., 6 months during the implementation period and up to 6 months post the implementation period|Paper Advance Care Planning Documentation Rates, Defined as the number of patients who were mailed and completed the advance care planning tool (ACPVoice) via mail., 6 months during the implementation period and up to 6 months post the implementation period|Preference-concordant care, Data will be collected via Redcap survey asking "How strongly do you agree or disagree that your current medical/treatment plan meets your preferences"., 6 months during the implementation period and up to 6 months post the implementation period