- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04660422
Advance Care Planning: Communicating With Outpatients for Vital Informed Decision (ACP-COVID)
Advance Care Planning: Communicating With Outpatients for Vital Informed Decisions
Study Overview
Status
Conditions
Detailed Description
This study is investigating if the use of telehealth ACP Program will improve and sustain rates of ACP from the time that the intervention is implemented compared to two time periods prior to the intervention. The Comprehensive ACP Program combines two widely disseminated interventions to assess impact when used concurrently.
- One is VitalTalk clinician communication skills training (www.vitaltalk.org) during which the primary care clinicians will practice ACP with simulated patient actors under the guidance of a trained VitalTalk facilitator.
- The second is the ACP Decisions video decision aids (www.acpdecisions.org) which are directed to patients and provide education about ACP. This inclusive ACP approach treats patients and clinicians as equal stakeholders providing both with the communication skills and tools needed to make decisions about COVID-19 medical care before the toughest choices arise.
- The training is four cumulative hours, most of which is spent in communication skills work, and the remainder learning how to introduce the videos into one's practice. No patients participate in the training. The ambulatory practices included in this intervention gain access to the ACP Decisions videos, which can be introduced to patients. Videos may be seen in clinic or sent to patients' homes via an electronic or paper code.
- We will recruit up to 30 clinicians from participating clinics who completed the intervention training and ask them to complete a qualitative interview to learn about their experience with the ACP intervention.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
-
New York
-
New Hyde Park, New York, United States, 11040
- Northwell Health
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Clinic Eligibility: Clinics affiliated with Northwell Health may be included in the study.
- Clinician, Staff Eligibility: Any staff member identified by the site-PIs are affiliated with Northwell Health.
- Patient Eligibility: To be eligible for this study, individuals must be aged 65 or over, affiliated with the Northwell Health clinic. For each of the three periods of the study, those patients over the age of 65 who are engaged (e.g., seen in person, telehealth, etc.) with the clinic during that time period will be included in that time period
Exclusion Criteria:
- Individuals who are not yet adults (infants, children, teenagers)
- Pregnant women
- Prisoners
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Pre-COVID-19 ACP baseline
Two six-month control periods prior to the wide-scale implementation of the intervention, allow us to measure a baseline rate of ACP activity and identify the "pre-COVID-19 ACP baseline rate" and a "COVID-19 ACP baseline rate. September 15, 2019 - March 14, 2020, |
13,000 (total) patients aged 65 or older for our primary (completed advance care plans) outcome.
ACP can include designating a health care proxy, discussion of advance directives, goals-of-care discussions, CPR discussions, palliative care discussions and referrals, as well as hospice.
Each of these ACP outcomes will also be compared in secondary analyses using NLP.
These data will be obtained from the EHR.
All patient participants will only be included for medical record review.
|
COVID-19 rate
Two six-month control periods prior to the wide-scale implementation of the intervention, allow us to measure a baseline rate of ACP activity and identify the "pre-COVID-19 ACP baseline rate" and a "COVID-19 ACP baseline rate. March 15, 2020 - September 14, 2020 |
13,000 (total) patients aged 65 or older for our primary (completed advance care plans) outcome.
ACP can include designating a health care proxy, discussion of advance directives, goals-of-care discussions, CPR discussions, palliative care discussions and referrals, as well as hospice.
Each of these ACP outcomes will also be compared in secondary analyses using NLP.
These data will be obtained from the EHR.
All patient participants will only be included for medical record review.
|
ACP rate
ACP rate during the implementation period, which begins December 15, 2020 and continues for six months, to the rates in the previous two control periods December 15, 2020-June 15, 2021
|
13,000 (total) patients aged 65 or older for our primary (completed advance care plans) outcome.
ACP can include designating a health care proxy, discussion of advance directives, goals-of-care discussions, CPR discussions, palliative care discussions and referrals, as well as hospice.
Each of these ACP outcomes will also be compared in secondary analyses using NLP.
These data will be obtained from the EHR.
All patient participants will only be included for medical record review.
Clinicians will receive VitalTalk intensive communication skills training via highly structured Zoom conference.
They will learn skills relevant to discussions about ACP and COVID-19 including delivering serious news, eliciting goals of care, and managing difficult conversations via telehealth platforms.
All clinicians will also be trained remotely on the ACP Decisions Video Program using the ACP app.
Training will instruct clinicians on how to: 1. Introduce the COVID-19 videos to patients and caregivers; 2. Select the appropriate video(s) from the entire suite according to patients' needs; and, 3. Prescribe videos for patients and caregivers using the electronic platform.
The suite of ACP videos is designed to address common ACP decisions confronting patients at risk or with COVID-19 and the caregivers.
Training will instruct the clinicians on how to: i. more effectively communicate with patients regarding COVID- 19, ii.
have ACP conversations with patients, iii.
introduce the videos to patients and families, iv.
use the videos as an adjunct to ACP counseling by clinicians, v. select the appropriate video(s) from the entire suite as according to patients' needs, and, vi.
use the app or electronic platform for prescribing videos to be seen at home (telehealth visits), or to be viewed in clinic with an iPad.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate for Advanced Care Planning (ACP) documentation
Time Frame: 2 Years
|
This study tests the effects of an ACP Program that trains clinicians and provides patients with a video decision aid on rates of ACP among 13,000 patients at risk, or with, COVID-19.
All patients over 65 engaged with the enrolled clinics over the course of each time period in each of the three study periods will be included in the analysis.
Rates of ACP are determined by natural language processing data extraction of electronic health records.
Generalized linear mixed models will be used to compare outcomes between intervention and control periods.
|
2 Years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of orders for resuscitation preferences
Time Frame: 2 years
|
Same methodology as Primary Outcome
|
2 years
|
Rate of palliative care consultation
Time Frame: 2 years
|
Same methodology as Primary Outcome
|
2 years
|
Rate of referral to hospice
Time Frame: 2 years
|
Same methodology as Primary Outcome
|
2 years
|
Advanced Care Planning (ACP) documentation rates among under-represented minority groups.
Time Frame: 2 Years
|
The analysis will use a difference in differences approach comparing the changes from the control period to the intervention period between White and non-White racial minority and between non-Medicaid and Medicaid patients.
|
2 Years
|
Collaborators and Investigators
Sponsor
Collaborators
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 20-600
- UH3AG060626-03S1 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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