Advance Care Planning for Critical Care - A Prelude to Breaking Barriers

Advance Care Planning (ACP) is a process of 'reflection and communication, in which a person with decision-making capacity makes decisions regarding their future health and/or personal care in the event that they become incapable of consenting to or refusing treatment' Most Canadians have not planned for end-of-life Care and are at risk of aggressive medical care that may not be compatible with their wishes. This study aims to systematically evaluate local barriers to making personal choices with regards to life support interventions that can be provided in the contemporary Intensive Care Unit.

Study Overview

• Status: Completed
• Conditions: Advance Care Planning; End of Life Care
• Intervention / Treatment: Other: semi-structured interviews

Detailed Description

HYPOTHESIS: The overarching hypothesis is that the average layperson lacks sufficient knowledge about the aggressive life support measures used routinely in contemporary Critical Care to make informed decisions for themselves and their loved ones. Considering that most Canadians have not even heard of the term Advance Care Planning, it is likely that there is a gap in their knowledge and expectations of Critical Care. Such a gap can be bridged through education - the only caveat being that the individual should be in full possession of their faculties and can make informed decisions. This point is critical.

Thus this study uses a mixed methods (qualitative and quantitative) research design to address the following questions: 1) What is the state of knowledge about Critical Care interventions among healthy elderly laypersons in London, Ontario? 2) What are the barriers to formulating ACPs? 3) What opportunities exist for increasing ACP in the healthy elderly population? The primary objective of this proposal is to assess public knowledge of Critical Care interventions (and their outcomes) from the perspective of making Advance Care Plans. Secondary Objectives are 1) To evaluate local barriers to Advance Care Planning 2) To determine effective modes of education for Advance Care Planning that could be used for the community and in our hospital setting.

• Study Type: Observational
• Enrollment (Actual): 30

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • London, Ontario, Canada, N6A 5A5
      • London Health Sciences Centre
    • London, Ontario, Canada, N6A 5A5
      • Dr. Ravi Taneja

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Healthy lay persons living at home in London, ON.

Description

Inclusion Criteria:

• Members from the community who are i) > 55 yrs of age, ii) living in London Middlesex community, iii) not housebound, iv) in apparent good health and iv) have the ability to make independent decisions for themselves

Exclusion Criteria:

• Factors that preclude a meaningful interview (such as cognitive impairment, aphasia, profound hearing impairment, language barriers) or anticipated emotional burden with the proposed topic.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lay person perception and knowledge of various Critical Care interventions	This is a qualitative study. The primary objective of this proposal is to assess public knowledge of Critical Care interventions (and their outcomes) from the perspective of making Advance Care Plans. Examples of such interventions include but are not limited to Cardiopulmonary resuscitation, mechanical ventilation, dialysis and artificial feeding. Outcomes involve lay person knowledge, beliefs and perceptions of Critical care from the perspective of making Advance Care Plans.	1 year

Collaborators and Investigators

• Sponsor: Lawson Health Research Institute
• Investigators: Principal Investigator: Ravi Taneja, MBBS, London Health Sciences Centre

Publications and helpful links

General Publications

• Teixeira AA, Hanvey L, Tayler C, Barwich D, Baxter S, Heyland DK; Canadian Researchers at End of Life Network (CARENET). What do Canadians think of advanced care planning? Findings from an online opinion poll. BMJ Support Palliat Care. 2015 Mar;5(1):40-7. doi: 10.1136/bmjspcare-2013-000473. Epub 2013 Oct 4.
• Taneja R, Faden LY, Schulz V, Rawal A, Miller K, Bishop KA, Lingard L. Advance care planning in community dwellers: A constructivist grounded theory study of values, preferences and conflicts. Palliat Med. 2019 Jan;33(1):66-73. doi: 10.1177/0269216318803487. Epub 2018 Oct 4. No abstract available.

Study record dates

Study Major Dates

• Study Start (ACTUAL): September 1, 2015
• Primary Completion (ACTUAL): June 1, 2017
• Study Completion (ACTUAL): June 1, 2017

Study Registration Dates

• First Submitted: March 31, 2016
• First Submitted That Met QC Criteria: June 7, 2016
• First Posted (ESTIMATE): June 13, 2016

Study Record Updates

• Last Update Posted (ACTUAL): September 28, 2017
• Last Update Submitted That Met QC Criteria: September 27, 2017
• Last Verified: February 1, 2016

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Death
• Other Study ID Numbers: 106476

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO