Improving Advance Care Planning by Preparing Diverse Seniors for Decision Making

N/ACompletedNCT01990235

University of California, San Francisco541 enrolled

Overview

The objective of this proposal is to test whether a multi-media website (www.prepareforyourcare.org) that is focused on preparing older adults for communication and medical decision making can help people engage in advance care planning.

PREPARE is a website (www.prepareforyourcare.org) that teaches patients how to identify what is most important in life, how to communicate their preferences to clinicians and loved ones, and how to make informed decisions. It is written at a 5th grade level and includes voice-overs of text and closed captioning of videos that model advance care planning behaviors. The goal of this proposal is to test the efficacy of PREPARE plus an easy-to-read advance directive, versus an advance directive alone, to improve patient engagement in multiple advance care planning behaviors including discussions with surrogate decision makers and clinicians in addition to advance directive completion. The investigators will also determine whether PREPARE can empower and activate patients within clinical encounters with their clinicians and help to decrease health disparities in advance care planning.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

541

Conditions

Chronic Disease

Interventions

PREPARE InterventionBEHAVIORAL

At week 1, 3, 6, and 12 months, interviews (telephone or in person based on preference) by blinded staff will assess engagement in advance care planning(ACP), self-efficacy with ACP, and activation in and satisfaction with decision making. Blinded telephone interviews will also assess surrogate reports of patient engagement in ACP.

Eligibility

Sex: ALLMin age: 55 Years

Medical Language ↔ Plain English

Inclusion Criteria: * English-speaking older adults (≥55 years) * ≥ 2 chronic illnesses determined by International Classification of Diseases-9 (ICD-9) codes * ≥ 2 visits with an outpatient primary care clinician at San Francisco General Hospital in the past year * ≥2 additional outpatient/inpatient visits to San Francisco General Hospital in the past year Exclusion Criteria: * deaf, blind, or demented as determined by ICD-9 codes * too mentally or physically ill to participate as determined by their clinicians * Moderate or severe cognitive impairment as determined by the Short Portable Mental Status Questionnaire (SPMSQ), and mild cognitive impairment as determined by the SPMSQ plus an abnormal Mini-Cog * self-reported poor vision and inability to see the words on a newspaper * lack of a telephone * traveling or moving out of the area for ≥3 months during the study follow- up period

Locations (1)

San Francisco General Hospital and Trauma Center

San Francisco, California, United States

Outcomes

Primary Outcomes

New advance care planning documentation in the medical record

The primary outcome is documentation of ACP wishes in the medical record. ACP documentation for the purposes of this study includes legal advance directive forms or other documentation of patients wishes for medical care in clinical notes.

Time frame: 15 months after study enrollment

Secondary Outcomes

Self-reported engagement in advance care planning behaviors

Secondary outcomes were chosen to measure the full process of ACP. Using validated questionnaires, we will measure ACP behavior change processes, such as knowledge, contemplation, self-efficacy, and readiness, as well as several ACP actions, such as identifying a surrogate decision maker, identifying values and goals for medical care, choosing the level of leeway in surrogate decision making, discussing one's wishes with clinicians and surrogates, and documenting one's wishes in an advance directive.

Time frame: 12 months from baseline

Data from ClinicalTrials.gov

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