Integrated Multidisciplinary Patient and Family Advance Care Planning Trial

NCT03609658 | Completed Results

• 1 other identifier: IRB00049370
• Study Type: interventional
• Target: 146
• Locations: 1 country
• Sites: 9

Brief Summary

The purpose of this study is to compare ways to engage sick patients and their family members in Advance Care Planning (ACP) discussions. Two pathways will be tested, discussions using a Nurse Navigator led pathway versus usual care.

Conditions

Advance Care Planning

Keywords

Vulnerable Older Adults; Nurse Navigator; Usual Care; Family; Multimorbid patients

Outcome Measures

Primary Outcomes (5)

• Number of Patient's Documented Advance Care Planning Discussion- Nurse Navigator

  Reported as the number of documentations completed in the newly created ACP note template for nurse navigator note templates.

  End of Study (Month 13)

• Number of Patient's Documented Advance Care Planning Discussions - Provider

  Reported as the number of documentations completed in the newly created ACP note template for provider note templates.

  End of Study (Month 13)

• Quality of Advance Care Planning Discussion - Nurse Navigator

  Measured by the newly created ACP note template for both nurse navigator (score ranging from 0-8). Score of 5 or higher determines better outcome.

  End of Study (Month 13)

• Quality of Advance Care Planning Discussion - Provider

  Measured by the newly created ACP note template for provider note templates (score ranging from 0-15). Score of 8 or higher in the provider template determines better outcome.

  End of Study (Month 13)

• Quality of Advance Care Planning Discussion From the Patient's Perspective

  Measured by the Quality about End of Life (EOL) Communication (QOC), The instrument is reported as 2 subscales: "general communication skills" and "communication about end-of-life care." Score range for the subscales is 1-11 Higher scores determine better outcomes.

  End of Study (Month 13)

Secondary Outcomes (3)

• Advance Care Planning Billing Code Usage

  End of Study (Month 13)

• Number of Designated Surrogate Decision Makers

  End of Study (Month 13)

• Advance Directive Completion

  End of Study (Month 13)

Other Outcomes (7)

• Number of Medical Scope of Treatment (MOST) Discussions

  End of Study (Month 13)

• After-death Bereaved Family Member Interview

  Month 29

• Frequency of Patient Healthcare Utilization

  End of Study (Month 13)

Study Arms (2)

Nurse Navigator Pathway Group

EXPERIMENTAL

Participants in this Nurse Navigator led ACP pathway group will participate in ACP discussions, surveys, and participant visit(s) for duration of the study (12 months)

Behavioral: Nurse Navigator Pathway

Usual Care Group

SHAM COMPARATOR

Participants in the Usual Care group will follow usual daily living activities for the duration of the study (12 months).

Behavioral: Usual Care

Interventions

Nurse Navigator Pathway BEHAVIORAL

In the Nurse Navigator Pathway, nurse navigators are being used as leverage to: approach qualified patients to initiate advance care planning discussions, schedule advance care planning visit with patients' primary care provider to further discuss advance care planning and to mail advance care planning resources to patients after their initial advance care planning discussion.

Nurse Navigator Pathway Group

Usual Care BEHAVIORAL

In the Usual Care arm, there is no approach by nurse navigators to initiate advance care planning discussions and it does not have a structure advance care planning visit. Therefore, no further action is required for the patients who were randomly assigned to the usual care arm.

Usual Care Group

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Aged 65 or older patient within the Wake Forest/Cornerstone ACO
• Have seen their primary care provider within the Wake Forest/Cornerstone network in the past 12 months
• English speaking
• No documented Advance Directive in the EHR
• Impairments in either physical function, cognition, and/or frailty

You may not qualify if:

• No available proxy (e.g. in setting of cognitive impairment)
• Severe/advanced dementia
• Moderate to severe hearing loss
• Non-English speaking
• No phone number available for patient

Sponsors & Collaborators

• Wake Forest University Health Sciences: lead
• Duke University: collaborator

Study Sites (9)

Family & Community Medicine of Asheboro

Asheboro, North Carolina, 27203, United States

Location

Claremont Family Medicine

Claremont, North Carolina, 28610, United States

Location

Conover Family Practice

Conover, North Carolina, 28613, United States

Location

Chronic Complex Care

High Point, North Carolina, 27262, United States

Location

Cornerstone Internal Medicine at Westchester

High Point, North Carolina, 27262, United States

Location

High Point Family Practice

High Point, North Carolina, 27262, United States

Location

Thomasville Family Practice

Thomasville, North Carolina, 27360, United States

Location

Downtown Health Plaza

Winston-Salem, North Carolina, 27101, United States

Location

Wake Forest University Health Sciences

Winston-Salem, North Carolina, 27157, United States

Location

Related Publications (71)

• U.S. Census Bureau. International database. Table 094. Midyear population, by age and sex. Available at http://www.census.gov/population/www/projections/natdet-D1A.htmlExternal Web Site Icon.

  BACKGROUND

• Gomez-Batiste X, Martinez-Munoz M, Blay C, Amblas J, Vila L, Costa X, Espaulella J, Espinosa J, Constante C, Mitchell GK. Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: a cross-sectional study. Palliat Med. 2014 Apr;28(4):302-11. doi: 10.1177/0269216313518266. Epub 2014 Jan 8.

  PMID: 24403380 BACKGROUND

• "Methods for Analysis of the Financing and Use of Long-Term Services and Supports," supplemental material for Rising Demand for Long-Term Services and Supports for Elderly People (June 2013), www.cbo.gov/publication/44370.

  BACKGROUND

• Schoenborn NL, Cayea D, McNabney M, Ray A, Boyd C. Prognosis communication with older patients with multimorbidity: Assessment after an educational intervention. Gerontol Geriatr Educ. 2017 Oct-Dec;38(4):471-481. doi: 10.1080/02701960.2015.1115983. Epub 2016 Feb 17.

  PMID: 26885757 BACKGROUND

• Morrison RS. Research priorities in geriatric palliative care: an introduction to a new series. J Palliat Med. 2013 Jul;16(7):726-9. doi: 10.1089/jpm.2013.9499. Epub 2013 May 30. No abstract available.

  PMID: 23721426 BACKGROUND

• Signorielli N: Physical disabilities, impairment and safety,mental illness, and death. In: Mass Media Images and Impact on Health: A Sourcebook. Westport, CT: Greenwood Press, 1993, pp. 37-42.

  BACKGROUND

• Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005 May-Jun;3(3):223-8. doi: 10.1370/afm.272.

  PMID: 15928225 BACKGROUND

• Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M. Multimorbidity's many challenges. BMJ. 2007 May 19;334(7602):1016-7. doi: 10.1136/bmj.39201.463819.2C.

  PMID: 17510108 BACKGROUND

• Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011 Sep;10(4):430-9. doi: 10.1016/j.arr.2011.03.003. Epub 2011 Mar 23.

  PMID: 21402176 BACKGROUND

• Smith SM, O'Dowd T. Chronic diseases: what happens when they come in multiples? Br J Gen Pract. 2007 Apr;57(537):268-70. No abstract available.

  PMID: 17394728 BACKGROUND

• Taylor AW, Price K, Gill TK, Adams R, Pilkington R, Carrangis N, Shi Z, Wilson D. Multimorbidity - not just an older person's issue. Results from an Australian biomedical study. BMC Public Health. 2010 Nov 22;10:718. doi: 10.1186/1471-2458-10-718.

  PMID: 21092218 BACKGROUND

• Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007 Dec;22 Suppl 3(Suppl 3):391-5. doi: 10.1007/s11606-007-0322-1.

  PMID: 18026807 BACKGROUND

• Menotti A, Mulder I, Nissinen A, Giampaoli S, Feskens EJ, Kromhout D. Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly). J Clin Epidemiol. 2001 Jul;54(7):680-6. doi: 10.1016/s0895-4356(00)00368-1.

  PMID: 11438408 BACKGROUND

• Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu AL, Maltais D. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes. 2004 Sep 20;2:51. doi: 10.1186/1477-7525-2-51.

  PMID: 15380021 BACKGROUND

• Townsend A, Hunt K, Wyke S. Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use. BMJ. 2003 Oct 11;327(7419):837. doi: 10.1136/bmj.327.7419.837.

  PMID: 14551097 BACKGROUND

• Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012 Jul 7;380(9836):37-43. doi: 10.1016/S0140-6736(12)60240-2. Epub 2012 May 10.

  PMID: 22579043 BACKGROUND

• Smith SM, Soubhi H, Fortin M, Hudon C, O'Dowd T. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012 Sep 3;345:e5205. doi: 10.1136/bmj.e5205.

  PMID: 22945950 BACKGROUND

• Ryan A, Wallace E, O'Hara P, Smith SM. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health Qual Life Outcomes. 2015 Oct 15;13:168. doi: 10.1186/s12955-015-0355-9.

  PMID: 26467295 BACKGROUND

• Iezzoni LI. Multiple chronic conditions and disabilities: implications for health services research and data demands. Health Serv Res. 2010 Oct;45(5 Pt 2):1523-40. doi: 10.1111/j.1475-6773.2010.01145.x. Epub 2010 Aug 2.

  PMID: 21054370 BACKGROUND

• Quinones AR, Markwardt S, Botoseneanu A. Multimorbidity Combinations and Disability in Older Adults. J Gerontol A Biol Sci Med Sci. 2016 Jun;71(6):823-30. doi: 10.1093/gerona/glw035. Epub 2016 Mar 11.

  PMID: 26968451 BACKGROUND

• Kogan AC, Wilber K, Mosqueda L. Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review. J Am Geriatr Soc. 2016 Jan;64(1):e1-7. doi: 10.1111/jgs.13873. Epub 2015 Dec 2.

  PMID: 26626408 BACKGROUND

• Connors MH, Sachdev PS, Kochan NA, Xu J, Draper B, Brodaty H. Cognition and mortality in older people: the Sydney Memory and Ageing Study. Age Ageing. 2015 Nov;44(6):1049-54. doi: 10.1093/ageing/afv139.

  PMID: 26504121 BACKGROUND

• Bunn F, Goodman C, Burn AM. Multimorbidity and frailty in people with dementia. Nurs Stand. 2015 Sep 2;30(1):45-50. doi: 10.7748/ns.30.1.45.e9816.

  PMID: 26329088 BACKGROUND

• Bunn F, Burn AM, Goodman C, Rait G, Norton S, Robinson L, Schoeman J, Brayne C. Comorbidity and dementia: a scoping review of the literature. BMC Med. 2014 Oct 31;12:192. doi: 10.1186/s12916-014-0192-4.

  PMID: 25358236 BACKGROUND

• Campbell SE, Seymour DG, Primrose WR; ACMEPLUS Project. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing. 2004 Mar;33(2):110-5. doi: 10.1093/ageing/afh036.

  PMID: 14960424 BACKGROUND

• Hagerty RG, Butow PN, Ellis PM, Lobb EA, Pendlebury SC, Leighl N, MacLeod C, Tattersall MH. Communicating with realism and hope: incurable cancer patients' views on the disclosure of prognosis. J Clin Oncol. 2005 Feb 20;23(6):1278-88. doi: 10.1200/JCO.2005.11.138.

  PMID: 15718326 BACKGROUND

• Guiding principles for the care of older adults with multimorbidity: an approach for clinicians. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2012 Oct;60(10):E1-E25. doi: 10.1111/j.1532-5415.2012.04188.x. Epub 2012 Sep 19. No abstract available.

  PMID: 22994865 BACKGROUND

• Herrin J, Harris KG, Kenward K, Hines S, Joshi MS, Frosch DL. Patient and family engagement: a survey of US hospital practices. BMJ Qual Saf. 2016 Mar;25(3):182-9. doi: 10.1136/bmjqs-2015-004006. Epub 2015 Jun 16.

  PMID: 26082560 BACKGROUND

• Meghani SH, Hinds PS. Policy brief: the Institute of Medicine report Dying in America: Improving quality and honoring individual preferences near the end of life. Nurs Outlook. 2015 Jan-Feb;63(1):51-9. doi: 10.1016/j.outlook.2014.11.007. Epub 2014 Dec 11.

  PMID: 25645482 BACKGROUND

• Zelen M. A new design for randomized clinical trials. N Engl J Med. 1979 May 31;300(22):1242-5. doi: 10.1056/NEJM197905313002203.

  PMID: 431682 BACKGROUND

• Torgerson DJ, Roland M. What is Zelen's design? BMJ. 1998 Feb 21;316(7131):606. doi: 10.1136/bmj.316.7131.606. No abstract available.

  PMID: 9518917 BACKGROUND

• Torgerson D. The use of Zelen's design in randomised trials. BJOG. 2004 Jan;111(1):2. doi: 10.1111/j.1471-0528.2004.00033.x. No abstract available.

  PMID: 14687043 BACKGROUND

• House A, Knapp P. Informed consent. Trials that use Zelen's procedure should be acceptable. BMJ. 1997 Jul 26;315(7102):251. No abstract available.

  PMID: 9253287 BACKGROUND

• Adamson J, Cockayne S, Puffer S, Torgerson DJ. Review of randomised trials using the post-randomised consent (Zelen's) design. Contemp Clin Trials. 2006 Aug;27(4):305-19. doi: 10.1016/j.cct.2005.11.003. Epub 2006 Feb 7.

  PMID: 16455306 BACKGROUND

• Pate A, Candlish J, Sperrin M, Van Staa TP; GetReal Work Package 2. Cohort Multiple Randomised Controlled Trials (cmRCT) design: efficient but biased? A simulation study to evaluate the feasibility of the Cluster cmRCT design. BMC Med Res Methodol. 2016 Aug 26;16(1):109. doi: 10.1186/s12874-016-0208-1.

  PMID: 27566594 BACKGROUND

• Rockwood K, Mitnitski A, Song X, Steen B, Skoog I. Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc. 2006 Jun;54(6):975-9. doi: 10.1111/j.1532-5415.2006.00738.x.

  PMID: 16776795 BACKGROUND

• Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):722-7. doi: 10.1093/gerona/62.7.722.

  PMID: 17634318 BACKGROUND

• Pajewski NM, Williamson JD, Applegate WB, Berlowitz DR, Bolin LP, Chertow GM, Krousel-Wood MA, Lopez-Barrera N, Powell JR, Roumie CL, Still C, Sink KM, Tang R, Wright CB, Supiano MA; SPRINT Study Research Group. Characterizing Frailty Status in the Systolic Blood Pressure Intervention Trial. J Gerontol A Biol Sci Med Sci. 2016 May;71(5):649-55. doi: 10.1093/gerona/glv228. Epub 2016 Jan 11.

  PMID: 26755682 BACKGROUND

• Drubbel I, de Wit NJ, Bleijenberg N, Eijkemans RJ, Schuurmans MJ, Numans ME. Prediction of adverse health outcomes in older people using a frailty index based on routine primary care data. J Gerontol A Biol Sci Med Sci. 2013 Mar;68(3):301-8. doi: 10.1093/gerona/gls161. Epub 2012 Jul 25.

  PMID: 22843671 BACKGROUND

• Gonzalez-Colaco Harmand M, Meillon C, Bergua V, Tabue Teguo M, Dartigues JF, Avila-Funes JA, Amieva H. Comparing the predictive value of three definitions of frailty: Results from the Three-City study. Arch Gerontol Geriatr. 2017 Sep;72:153-163. doi: 10.1016/j.archger.2017.06.005. Epub 2017 Jun 17.

  PMID: 28666213 BACKGROUND

• Rothman MD, Leo-Summers L, Gill TM. Prognostic significance of potential frailty criteria. J Am Geriatr Soc. 2008 Dec;56(12):2211-16. doi: 10.1111/j.1532-5415.2008.02008.x.

  PMID: 19093920 BACKGROUND

• Roe L, Normand C, Wren MA, Browne J, O'Halloran AM. The impact of frailty on healthcare utilisation in Ireland: evidence from the Irish longitudinal study on ageing. BMC Geriatr. 2017 Sep 5;17(1):203. doi: 10.1186/s12877-017-0579-0.

  PMID: 28874140 BACKGROUND

• Laniece I, Couturier P, Drame M, Gavazzi G, Lehman S, Jolly D, Voisin T, Lang PO, Jovenin N, Gauvain JB, Novella JL, Saint-Jean O, Blanchard F. Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units. Age Ageing. 2008 Jul;37(4):416-22. doi: 10.1093/ageing/afn093. Epub 2008 May 16.

  PMID: 18487268 BACKGROUND

• Campitelli MA, Bronskill SE, Hogan DB, Diong C, Amuah JE, Gill S, Seitz D, Thavorn K, Wodchis WP, Maxwell CJ. The prevalence and health consequences of frailty in a population-based older home care cohort: a comparison of different measures. BMC Geriatr. 2016 Jul 7;16:133. doi: 10.1186/s12877-016-0309-z.

  PMID: 27388294 BACKGROUND

• Gill TM, Allore HG, Gahbauer EA, Murphy TE. Change in disability after hospitalization or restricted activity in older persons. JAMA. 2010 Nov 3;304(17):1919-28. doi: 10.1001/jama.2010.1568.

  PMID: 21045098 BACKGROUND

• Hubbard RE, Peel NM, Samanta M, Gray LC, Mitnitski A, Rockwood K. Frailty status at admission to hospital predicts multiple adverse outcomes. Age Ageing. 2017 Sep 1;46(5):801-806. doi: 10.1093/ageing/afx081.

  PMID: 28531254 BACKGROUND

• Fried LP, Kronmal RA, Newman AB, Bild DE, Mittelmark MB, Polak JF, Robbins JA, Gardin JM. Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. JAMA. 1998 Feb 25;279(8):585-92. doi: 10.1001/jama.279.8.585.

  PMID: 9486752 BACKGROUND

• Turner G, Clegg A; British Geriatrics Society; Age UK; Royal College of General Practioners. Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing. 2014 Nov;43(6):744-7. doi: 10.1093/ageing/afu138.

  PMID: 25336440 BACKGROUND

• Bugarski V, Sakac V, Vodopivec S, Slankamenac P. Relation between personality dimensions and depressive symptoms in patients on hemodialysis. Med Pregl. 2010 May-Jun;63(5-6):305-12. doi: 10.2298/mpns1006305b. English, Serbian.

  PMID: 21180270 BACKGROUND

• Clegg A, Bates C, Young J, Ryan R, Nichols L, Ann Teale E, Mohammed MA, Parry J, Marshall T. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016 May;45(3):353-60. doi: 10.1093/ageing/afw039. Epub 2016 Mar 3.

  PMID: 26944937 BACKGROUND

• Castanho TC, Amorim L, Zihl J, Palha JA, Sousa N, Santos NC. Telephone-based screening tools for mild cognitive impairment and dementia in aging studies: a review of validated instruments. Front Aging Neurosci. 2014 Feb 25;6:16. doi: 10.3389/fnagi.2014.00016. eCollection 2014.

  PMID: 24611046 BACKGROUND

• Roccaforte WH, Burke WJ, Bayer BL, Wengel SP. Reliability and validity of the Short Portable Mental Status Questionnaire administered by telephone. J Geriatr Psychiatry Neurol. 1994 Jan-Mar;7(1):33-8.

  PMID: 8192828 BACKGROUND

• Moorman SM, Carr D, Kirchhoff KT, Hammes BJ. An assessment of social diffusion in the Respecting Choices advance care planning program. Death Stud. 2012 Apr;36(4):301-22. doi: 10.1080/07481187.2011.584016.

  PMID: 24567988 BACKGROUND

• Rietjens JA, Korfage IJ, Dunleavy L, Preston NJ, Jabbarian LJ, Christensen CA, de Brito M, Bulli F, Caswell G, Cerv B, van Delden J, Deliens L, Gorini G, Groenvold M, Houttekier D, Ingravallo F, Kars MC, Lunder U, Miccinesi G, Mimic A, Paci E, Payne S, Polinder S, Pollock K, Seymour J, Simonic A, Johnsen AT, Verkissen MN, de Vries E, Wilcock A, Zwakman M, van der Heide Pl A. Advance care planning--a multi-centre cluster randomised clinical trial: the research protocol of the ACTION study. BMC Cancer. 2016 Apr 8;16:264. doi: 10.1186/s12885-016-2298-x.

  PMID: 27059593 BACKGROUND

• Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK. Prognostic indices for older adults: a systematic review. JAMA. 2012 Jan 11;307(2):182-92. doi: 10.1001/jama.2011.1966.

  PMID: 22235089 BACKGROUND

• Sudore RL, Landefeld CS, Barnes DE, Lindquist K, Williams BA, Brody R, Schillinger D. An advance directive redesigned to meet the literacy level of most adults: a randomized trial. Patient Educ Couns. 2007 Dec;69(1-3):165-95. doi: 10.1016/j.pec.2007.08.015. Epub 2007 Oct 17.

  PMID: 17942272 BACKGROUND

• Sudore RL, Barnes DE, Le GM, Ramos R, Osua SJ, Richardson SA, Boscardin J, Schillinger D. Improving advance care planning for English-speaking and Spanish-speaking older adults: study protocol for the PREPARE randomised controlled trial. BMJ Open. 2016 Jul 11;6(7):e011705. doi: 10.1136/bmjopen-2016-011705.

  PMID: 27401363 BACKGROUND

• http://www.gotplans123.org/.

  BACKGROUND

• Ito M, Nakajima S, Fujisawa D, Miyashita M, Kim Y, Shear MK, Ghesquiere A, Wall MM. Brief measure for screening complicated grief: reliability and discriminant validity. PLoS One. 2012;7(2):e31209. doi: 10.1371/journal.pone.0031209. Epub 2012 Feb 14.

  PMID: 22348057 BACKGROUND

• Shear KM, Jackson CT, Essock SM, Donahue SA, Felton CJ. Screening for complicated grief among Project Liberty service recipients 18 months after September 11, 2001. Psychiatr Serv. 2006 Sep;57(9):1291-7. doi: 10.1176/ps.2006.57.9.1291.

  PMID: 16968758 BACKGROUND

• Mori M, Yoshida S, Shiozaki M, et al.

  BACKGROUND

• Yamaguchi T, Maeda I, Hatano Y, Mori M, Shima Y, Tsuneto S, Kizawa Y, Morita T, Yamaguchi T, Aoyama M, Miyashita M. Effects of End-of-Life Discussions on the Mental Health of Bereaved Family Members and Quality of Patient Death and Care. J Pain Symptom Manage. 2017 Jul;54(1):17-26.e1. doi: 10.1016/j.jpainsymman.2017.03.008. Epub 2017 Apr 24.

  PMID: 28450216 BACKGROUND

• Glidden DV, Vittinghoff E. Modelling clustered survival data from multicentre clinical trials. Stat Med. 2004 Feb 15;23(3):369-88. doi: 10.1002/sim.1599.

  PMID: 14748034 BACKGROUND

• Fine, J., & Gray, R. (1999). A Proportional Hazards Model for the Subdistribution of a Competing Risk. Journal of the American Statistical Association, 94(446), 496-509. doi:10.2307/2670170.

  BACKGROUND

• Dong H, Robison LL, Leisenring WM, Martin LJ, Armstrong GT, Yasui Y. Estimating the burden of recurrent events in the presence of competing risks: the method of mean cumulative count. Am J Epidemiol. 2015 Apr 1;181(7):532-40. doi: 10.1093/aje/kwu289. Epub 2015 Feb 17.

  PMID: 25693770 BACKGROUND

• Prentice R, Williams B, and Peterson A. On the regression analysis of multivariate failure time data. Biometrika 1981;68:373-379. .

  BACKGROUND

• Julious SA. Sample Sizes for Clinical Trials. Chapman & Hall/CRC, Boca Raton, FL, 2010.

  BACKGROUND

• Reeves D, Howells K, Sidaway M, Blakemore A, Hann M, Panagioti M, Bower P. The cohort multiple randomized controlled trial design was found to be highly susceptible to low statistical power and internal validity biases. J Clin Epidemiol. 2018 Mar;95:111-119. doi: 10.1016/j.jclinepi.2017.12.008. Epub 2017 Dec 19.

  PMID: 29277558 BACKGROUND

• Sudore RL, Boscardin J, Feuz MA, McMahan RD, Katen MT, Barnes DE. Effect of the PREPARE Website vs an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement Among Veterans: A Randomized Clinical Trial. JAMA Intern Med. 2017 Aug 1;177(8):1102-1109. doi: 10.1001/jamainternmed.2017.1607.

  PMID: 28520838 BACKGROUND

• Gabbard J, Pajewski NM, Callahan KE, Dharod A, Foley KL, Ferris K, Moses A, Willard J, Williamson JD. Effectiveness of a Nurse-Led Multidisciplinary Intervention vs Usual Care on Advance Care Planning for Vulnerable Older Adults in an Accountable Care Organization: A Randomized Clinical Trial. JAMA Intern Med. 2021 Mar 1;181(3):361-369. doi: 10.1001/jamainternmed.2020.5950.

  PMID: 33427851 DERIVED

• Gabbard J, Pajewski NM, Callahan KE, Dharod A, Foley K, Ferris K, Moses A, Grey C, Williamson J. Advance care planning for vulnerable older adults within an Accountable Care Organization: study protocol for the IMPACT randomised controlled trial. BMJ Open. 2019 Dec 15;9(12):e032732. doi: 10.1136/bmjopen-2019-032732.

  PMID: 31843844 DERIVED

Results Point of Contact

• Title: Jennifer Gabbard, M.D.
• Organization: Wake Forest School of Medicine

jgabbard@wakehealth.edu

336-716-8028

Study Officials

• Jennifer Gabbard, MD

  Wake Forest University Health Sciences

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: There are two groups. All participants are randomized prior to informed consent, and then only patients randomized to the interventional arm are approached for consent and subsequently enrolled in the intervention group. Note that patients that do not consent to the intervention are still counted as part of control group under an intent-to-treat paradigm, which necessitates passive ascertainment mechanisms for outcomes (i.e. administrative claims or the EHR).

Study Record Dates

• First Submitted: July 25, 2018
• First Posted: August 1, 2018
• Study Start: November 2, 2018
• Primary Completion: December 10, 2019
• Study Completion: December 10, 2019
• Last Updated: August 6, 2021
• Results First Posted: August 6, 2021

Record last verified: 2021-06

Data Sharing

• IPD Sharing: Will not share

Locations

US (9)