Advance Care Planning Evaluation in Hospitalized Elderly Patients

NCT01362855 | Completed

• 1 other identifier: ACCEPT Study
• Study Type: observational
• Target: 503
• Locations: 1 country
• Sites: 9

Brief Summary

The purpose of the study is to inform decision-makers of the best strategies to implement advanced care planning (ACP). An advanced care plan (ACP) is a verbal or written instruction describing what kind of care an individual would want (or not want)if they are no longer able speak for themselves to make health care decisions.

Conditions

Critical Illness; Chronic Obstructive Lung Disease; Congestive Heart Failure; Cirrhosis; Cancer

Keywords

Advance Care Planning; End of life; Knowledge translation; Goals of care; Advance directive; Living will

Outcome Measures

Primary Outcomes (1)

• Extent of Implementation of ACP

  a. Does the patient have an advance directive or living will or some other written document expressing their wishes? b.patient and/or family been informed of the patients' prognosis? c.Has the patient and/or family been informed about the expected benefits and burdens of various treatment options? d.Has the patient considered how s/he wants to live in the final stages of life and what kinds of medical treatments they would want or not want? e.Have they discussed this with their family? A health care provider? g.Has there been a discussion about their goals of care with their health care provider? If so, are they aware of them? h.Has there been a decision made about medical treatments at the end of life? If so, what role did the patient/family play in that decision-making and was this consistent with their preferred role? i.Is there documentation in the medical record of the overall goals of care?

  Year 3

Secondary Outcomes (4)

• Effect of an audit and feedback process plus tailored interventions ACP

  Year 3

• Impact of ACP on patient/family satisfaction

  Year 3

• ACP components associated with overall satisfaction

  Year 3

• Comparison of sites with low vs high system level implementation of ACP on satisfaction

  Year 3

Eligibility Criteria

• Age: 55 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

We will enroll patients who are at high risk of dying and/or their families (where available).

You may qualify if:

• years or older with one or more of the following diagnoses:
• Chronic obstructive lung disease - 2 of the 4 of: baseline PaCO2 of \> 45 torr, cor pulmonale; respiratory failure episode within the preceding year; forced expiratory volume in 1 sec \<0.5 L.
• Congestive heart failure - New York Heart Association class IV symptoms and left ventricular ejection fraction \< 25%.
• Cirrhosis - confirmed by imaging studies or documentation of esophageal varices and one of three conditions: a) hepatic coma, b) Child's class C liver disease, or c) Child's class B liver disease with gastrointestinal bleeding.
• Cancer - metastatic cancer or stage IV lymphoma.
• End-stage dementia (inability to perform all ADLs, mutism or minimal verbal output secondary to dementia, bed-bound state prior to acute illness) OR
• Any patient 80 years of age or older admitted to hospital from the community because of an acute medical or surgical condition.

You may not qualify if:

• Non-English speaking patient/family member
• Patient with cognitive impairment

Sponsors & Collaborators

• Daren K. Heyland: lead
• Canadian Institutes of Health Research (CIHR): collaborator

Study Sites (9)

Peter Lougheed Hospital

Calgary, Alberta, T1Y 6J4, Canada

Location

Foothills Medical Centre

Calgary, Alberta, Canada

Location

Royal Alexandra Hospital

Edmonton, Alberta, T5H 3V9, Canada

Location

Royal Columbian Hospital

New Westminster, British Columbia, V3L 3W4, Canada

Location

Vancouver Hospital

Vancouver, British Columbia, V5Z 1C6, Canada

Location

St Paul's Hospital

Vancouver, British Columbia, V6Z 1Y6, Canada

Location

St.Paul's Hospital

Vancouver, British Columbia, V6Z 1Y6, Canada

Location

Hamilton General Hospital

Hamilton, Ontario, Canada

Location

Kingston General Hospital

Kingston, Ontario, K7L 2V7, Canada

Location

Related Publications (2)

• Heyland DK, Heyland R, Dodek P, You JJ, Sinuff T, Hiebert T, Jiang X, Day AG; ACCEPT Study Team and the Canadian Researchers at the End of Life Network (CARENET). Discordance between patients' stated values and treatment preferences for end-of-life care: results of a multicentre survey. BMJ Support Palliat Care. 2017 Sep;7(3):292-299. doi: 10.1136/bmjspcare-2015-001056. Epub 2016 Oct 6.

  PMID: 28827369 DERIVED

• Heyland DK, Dodek P, You JJ, Sinuff T, Hiebert T, Tayler C, Jiang X, Simon J, Downar J; ACCEPT Study Team and the Canadian Researchers at the End of Life Network (CARENET). Validation of quality indicators for end-of-life communication: results of a multicentre survey. CMAJ. 2017 Jul 31;189(30):E980-E989. doi: 10.1503/cmaj.160515.

  PMID: 28760834 DERIVED

MeSH Terms

Conditions

Critical Illness; Pulmonary Disease, Chronic Obstructive; Heart Failure; Fibrosis; Neoplasms; Death

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Lung Diseases, Obstructive; Lung Diseases; Respiratory Tract Diseases; Chronic Disease; Heart Diseases; Cardiovascular Diseases

Study Officials

• Daren K Heyland, MD, MSc

  Queen's University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Director, Clinical Evaluation Reserach Unit

Study Record Dates

• First Submitted: May 20, 2011
• First Posted: May 30, 2011
• Study Start: September 1, 2011
• Primary Completion: March 1, 2015
• Study Completion: May 1, 2015
• Last Updated: December 16, 2020

Record last verified: 2015-02

Locations

CA (9)