Advance Care Planning (ACP) in Primary Care for Dementia

NCT05322317 | Completed

• 1 other identifier: STUDY00023109
• Study Type: interventional
• Target: 17
• Locations: 1 country
• Sites: 1

Brief Summary

ADVANCE-PC: Aligning Dementia \& adVANce Care planning Education in Primary Care, is a communications and implementation support intervention that builds on existing ACP programs, understanding of dementia, and clinical expertise to provide training and technical assistance tailored to the needs of primary care clinicians and clinics that are often over-burdened and under-resourced. For this pilot, we will recruit six primary care clinics to test the ADVANCE-PC delivered using remote technology (ECHO). The pilot will include conducting one ECHO cycle and assessing the feasibility and acceptability of the program content and this mode of delivery (Aim 1) and testing pragmatic outcome assessment for the intervention (Aim 2).

Conditions

Dementia; Advance Care Planning

Keywords

dementia; advance care planning; primary care; ECHO

Outcome Measures

Primary Outcomes (2)

• Percentage of enrolled participants who attend 80% of ECHO program sessions

  number of participants who attended 80% of sessions/number of enrolled participants

  5 months after start of program

• Proportion of patients with dementia and/or their care partners seen by participating clinicians who are engaged in ACP.

  Primary care clinics will identify: patients with dementia and/or their care partners who have visits with participating clinicians during the study period (denominator) and track the number of these people who are engaged in advance planning during the project period (numerator)

  8 months after start of program

Secondary Outcomes (2)

• Participating clinician satisfaction rating: questionnaire designed for this study

  8 months from start of ECHO program

• Percentage of enrolled participants who plan to continue to engage patients with dementia in ACP

  8 months after start of program

Study Arms (1)

Pilot participants

OTHER

Participants will participate in ADVANCE-PC training via ECHO and will receive practice facilitation support, if needed. To assess the feasibility of the ADVANCE-PC training and implementation support, research data will be collected from participating clinicians at three time points. Two data collection points will be pre and post ECHO program training questionnaires about attitudes, experience, and intentions related to ACP and dementia. The third will be an interview at the end of the follow-up period, focusing on barriers to and facilitators of ACP in the context of dementia and the impact of the training and implementation support. Feasibility and acceptability of this intervention will be evaluated using descriptive and qualitative analyses of these data.

Other: ADVANCE-PC training via ECHO

Interventions

ADVANCE-PC training via ECHO OTHER

To assess the feasibility of using a technology-based platform to deliver the ADVANCE-PC program to multiple primary care clinics. This model will be based on the ECHO program, a tele-mentoring program which uses communications technology to provide facilitated education, case review, and peer-to-peer problem solving remotely. Our working hypothesis is that the use of ECHO will be efficient (allowing several clinicians and teams to be supported simultaneously while creating a community of practice), feasible (that clinicians will enroll and share experiences via mentoring, guidance, feedback, and didactic education), and have the potential to impact patients as clinicians perceptions shift to favor ACP, their skills increase, and they are able to integrate ACP for patients with dementia into their clinic.

Pilot participants

Eligibility Criteria

• Age: 18 Years - 105 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Clinic Level
• The program will be offered to six primary care clinics. Each must meet the following criteria:
• Be a member in a practice-based research network (PBRN) within the Meta-network Learning and Research Center (Meta-LARC),
• Have a functional EHR,
• Have leadership that agrees to clinic participation, and
• Is willing to attempt to track and report the number of eligible patients (those with dementia seen in the clinic by program-trained clinicians) and the number of these patients and/or care partners that received ACP from these program-trained clinicians during a 5-month follow-up period.
• Clinician/Staff Level
• Willing to participate in ECHO sessions,
• Willing to work on ACP implementation between sessions, and
• Be highly likely to have visits with at least 8 patients with dementia and/or their care partners in a 5-month follow-up period.
• Adults of any age and pregnant people will be allowed to participate. Primary care clinicians and staff will all be over 18 years old and there is no maximum age limit for participation. It is possible that a primary care clinician or staff member who participates may be pregnant. This research does not inquire about pregnancy status and there is no added risk to the fetus in including a pregnant person in professional training.

You may not qualify if:

• Children and adolescents, as the target population is primary care clinicians, patient care team members, and primary care clinic staff;
• Clinicians who do not provide primary care;
• Primary care clinicians who do not care for patients with dementia; and
• Primary care clinics that do not have sufficient clinicians (6 clinicians or team members) or sufficient patients (at least 8 patients each) with dementia to meet the pilot test targets.

Sponsors & Collaborators

• Oregon Health and Science University: lead
• University of Colorado, Denver: collaborator

Study Sites (1)

Oregon Health & Science University

Portland, Oregon, 97239, United States

Location

MeSH Terms

Conditions

Dementia

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Mental Disorders

Study Officials

• Annette M Totten, PhD

  Oregon Health and Science University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor and Core Investigator of Medical Informatics and Clinical Epidemiology, School of Medicine

Model Details: This is a prospective pilot study designed to achieve the objectives listed above. This project focuses on implementing ACP (which is an accepted best practice) and using ECHO (which is an evidence-based existing professional development model in healthcare). The research component involves data collection from clinicians and clinics in addition to what would be normally collected for as part of the training program and for quality improvement (QI).

Study Record Dates

• First Submitted: March 10, 2022
• First Posted: April 11, 2022
• Study Start: April 21, 2022
• Primary Completion: November 3, 2022
• Study Completion: November 9, 2022
• Last Updated: November 18, 2022

Record last verified: 2022-11

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)