A randomized controlled trial of a video decision aid in the Emergency Department Setting to improve advance care planning documentation.
A randomized controlled trial of a video decision aid in the Emergency Department setting shown to patients followed by a brief advance care planning discussion and then relay that discussion to the patient's primary care provider and/or admitting clinical team and look at rates of advance care planning documentation in the electronic health record over time. Primary outcome is advance care planning documentation in the EHR at 3 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
900
advance care planning video decision aid
control arm ACP information sheet
UC Davis
Davis, California, United States
Massachusetts General Hospital
Boston, Massachusetts, United States
Brigham and Women's Hospital
Boston, Massachusetts, United States
Newton Wellesley Hospital
Newton, Massachusetts, United States
EHR documentation of advance care planning
EHR documentation of advance care planning
Time frame: 3 months
patient reported conversations with health care providers and family
patient reported conversations with health care providers and family
Time frame: at 3 and 6 months
concordance between stated and documented preferences
concordance between stated and documented preferences
Time frame: at 3 and 6 months
ACP documentation in the EHR
ACP documentation in the EHR
Time frame: at 6 months
hospitalization
hospitalization
Time frame: at 3 and 6 months
differential intervention effects of the ACP video intervention on patient ACP documentation based on race and ethnicity
We will look at ACP documentation in the intervention and control arms to see if there are differential intervention effects based on race and ethnicity. We will look at the ACP documentation rate in Whites in both arms, and compare them to African Americans and Latinx populations. We will be able to see if the intervention had a greater or lesser effect on ACP rates in sub groups of our population by race and ethnicity.
Time frame: at baseline, 3 and 6 months
quality of clinician ACP communication using an ACP quality communication survey
quality of ACP communication using an ACP quality communication survey
Time frame: quality of communication at the time of the survey interview (baseline), and then at 3 and 6 months
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place of death
place of death
Time frame: at 3 and 6 months
enrollment in hospice
enrollment in hospice
Time frame: at 3 and 6 months
ED visits
ED visits
Time frame: at 3 and 6 months
mortality
mortality
Time frame: at 3 and 6 months
ICU days
ICU days
Time frame: at 3 and 6 months
patient CPR and breathing machine preferences
we will ask the patient whether or not they want CPR attempted and whether they would wish to be placed on a breathing machine
Time frame: at time of survey (baseline) and then after 3 and 6 months
patient preferences for goals of care
We will ask patient if they wish to receive life prolonging care, limited care or comfort care.
Time frame: at time of survey (baseline) and then after 3 and 6 months
decisional certainty regarding decision making for ACP preferences
we will ask patients how certain they are about their decisions for the goals of care
Time frame: at baseline survey interview
patient knowledge of ACP
We will ask patients knowledge questions about their understanding of advance care planning
Time frame: at baseline survey interview
patient confidence in health care delivery that is aligned with patient preferences
We will ask patients how confident they are in that they will receive the type of medical care they wish in their health care system
Time frame: at time of survey (baseline) and then after 3 and 6 months
patient ACP engagement with ACP topics
We will ask patients how ready and engaged they are with the topic of advance care planning
Time frame: at baseline survey interview