Involving Nursing Home Residents and Their Families in Acute Care Transfer Decisions

NCT02568475 | Completed Results

• 2 other identifiers: 3432681IP2PI000281-01
• Study Type: interventional
• Target: 192
• Locations: 1 country
• Sites: 1

Brief Summary

This study addresses the Patient-Centered Outcomes Research Institute (PCORI) area of interest related to development of decision support tools that bring patients, families and clinicians together to decide, in this instance, whether or not transfer from the nursing home (NH) to acute care is necessary and appropriate. The purposes of this study were 1) to develop an evidence-based decision aid addressing potentially avoidable transfers of residents from nursing homes to hospitals (preceded this protocol), and 2) to evaluate this decision aid in terms of acceptability to residents and families and its effect on the quality of transfer decisions. The primary hypotheses to be tested are: Hypothesis 1: Resident and family members in the intervention group will report greater preparation for decision making and less decisional conflict than those in the no treatment control group. Hypothesis 2: Residents and family members in the intervention group will demonstrate increased knowledge related to acute care transfer and less preference for acute care transfer than those in the no treatment control group.

Conditions

Chronic Disease; Acute Disease

Keywords

nursing home residents, decision aid, acute care transfers

Outcome Measures

Primary Outcomes (2)

• Preparation for Decision Making

  Range of possible raw scores: 10 - 50. Items can be summed and scored (sum the 10 items and divide by 10). There are no subscales. A higher score is positive indicating perception of being better prepared to make the decision identified when test is administered.

  Decision Aid group only: Post test (2-3 weeks after pretest) and at 3 month follow-up (after post test)

• Decisional Conflict Scale

  Scale Range of possible raw scores: 0 - 64. A lower score indicates less decisional conflict related to making the identified decision. Decisional conflict is a state of uncertainty about a course of action. Decision supporting interventions are thought to be effective in

  Decision aid: Pretest (baseline) and Post test (2-3 weeks after pretest); No decision aid: Post test only

Secondary Outcomes (3)

• Knowledge Test

  Pretest (baseline) and Post test (2-3 weeks after pretest)

• Treatment Preference/Decisional Conflict Scale

  Post test (2-3 weeks after pretest)

• 30 Day Hospital Readmission

  Length of stay ≤30 days at Post test

Study Arms (2)

Decision aid

EXPERIMENTAL

Provision of "Go to the Hospital or Stay Here?"

Behavioral: Provision of "Go to the Hospital or Stay Here?"

No decision aid

NO INTERVENTION

Does not receive the decision aid.

Interventions

Provision of "Go to the Hospital or Stay Here?" BEHAVIORAL

Residents and families randomly assigned to the intervention group (one half of the residents and one half of the families enrolled) are given the new Decision Aid to review with an RA trained for this purpose by the investigators. The Decision Aid provides information on risks and benefits of acute care transfer and information on advance care planning, resident and families' right to be involved in the decision. Resident or family member is also asked to re-read it and think about it over the subsequent 14 days.

Also known as: Transfer Decision Guide

Decision aid

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult nursing home resident and/or family member or identified significant other of a nursing home resident. Cognitively unimpaired individuals. Long or short term residents of nursing home or rehabilitation center.

You may not qualify if:

• Dementia as indicated by score on Mini-Cog. Inability to respond to questions due to physical disability or illness.

Sponsors & Collaborators

• Florida Atlantic University: lead

Study Sites (1)

Florida Atlantic University, Christine E. Lynn College of Nursing

Boca Raton, Florida, 33431, United States

Location

Related Publications (1)

• Tappen RM, Worch SM, Elkins D, Hain DJ, Moffa CM, Sullivan G. Remaining in the nursing home versus transfer to acute care: resident, family, and staff preferences. J Gerontol Nurs. 2014 Oct;40(10):48-57. doi: 10.3928/00989134-20140807-01.

  PMID: 25275783 RESULT

MeSH Terms

Conditions

Chronic Disease; Acute Disease

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Results Point of Contact

• Title: Ruth M. Tappen, Principal Investigator
• Organization: Florida Atlantic University

rtappen@health.fau.edu

561-297-2613

Study Officials

• Ruth M. Tappen, EdD, RN, FAAN

  Christine E. Lynn College of Nursing, Florida Atlantic University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Christine E. Lynn Eminent Scholar and Professor

Study Record Dates

• First Submitted: October 2, 2015
• First Posted: October 6, 2015
• Study Start: October 1, 2012
• Primary Completion: September 1, 2015
• Study Completion: September 1, 2015
• Last Updated: August 31, 2020
• Results First Posted: August 31, 2020

Record last verified: 2020-08

Locations

US (1)