Goals of Care Conversations Study

Conditions

• Cancer
• Chronic Obstructive Pulmonary Disease
• Dementia
• End-stage Liver Disease
• End-stage Renal Disease
• Heart Failure
• Interstitial Lung Disease
• Seriously Ill Patients

Eligibility Criteria

Sex

ALL

Age

18 Years - N/A

Healthy Volunteers

Not accepted

Interventions

• Clinician Implementation Strategy Stage 1: low intensity clinician training — BEHAVIORAL
  A "booster" of the established LSTDI implementation strategy. Clinicians will be presented with summary written/electronic materials on the LSTDI developed for the study. Online training options and when and how to complete goals of care conversations and documentation will be highlighted.
• Clinician Implementation Strategy Stage 2: high intensity clinician training — BEHAVIORAL
  This includes two components: 1. Team facilitation to help the primary care team (advance practice provider, nurse, social worker) work together to create roles and responsibilities for accomplishing goals of care conversations with patients 2. A patient list "trigger" of patients potentially eligible for goals of care conversations (the patient study population) will be sent to the primary care clinicians.
• Low patient engagement — BEHAVIORAL
  Patients will be sent information about goals of care conversations, including the PREPARE website.
• High patient engagement — BEHAVIORAL
  Patients will be sent information about goals of care conversations, including the PREPARE website. Follow-up phone calls to discuss goals of care conversations and the PREPARE website will be made.

Study Details

The long term goal is to improve quality of care in Veterans with serious illnesses by aligning medical care with Veterans' goals and values. The objective of this study is to use a sequentially randomized trial to determine what implementation strategies are effective to increase early, outpatient goals of care conversations. The study will use interviews with and surveys of medical providers, patients, and caregivers, along with medical record data. This work is significant because it tests ways Veterans can express their goals and preferences for life sustaining treatments and have them honored.

Key Dates

Start date

Sep 13, 2022

Status verified

Dec 2024

Primary completion

Sep 30, 2024

Completion

Sep 30, 2025

Study Design

Enrollment

72 participants (estimated)

Allocation

RANDOMIZED

Intervention model

SEQUENTIAL

Primary purpose

HEALTH_SERVICES_RESEARCH

Arms

• Active Comparator: No then high patient engagement
  First stage: No patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): High patient engagement and high intensity clinician training.
• Active Comparator: No then low patient engagement
  First stage: No patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): Low intensity patient engagement and high intensity clinician training.
• Active Comparator: Low then high patient engagement
  First stage: Low intensity patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): High patient engagement and high intensity clinician training.
• Active Comparator: Low then low patient engagement
  First stage: Low patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): Low intensity patient engagement and high intensity clinician training.

Primary Outcome Measure

Percent of patients with a goals of care conversation note documented in Stage 2 [ Time Frame: From the start of stage 2 to 9 months later ]

Locations (3)

Find similar trials in Palo Alto, CA

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