- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04730986
A Nurse-led, Advance Care Planning Intervention in the Emergency Department
A Nurse-led, Advance Care Planning Intervention in the Emergency Department: a Pilot Study
ED GOAL is a 6-minute, motivational interviewing, advance care planning intervention.
In this study, the investigators will pilot test (Part I) ED GOAL by training research nurses to demonstrate its intervention fidelity and acceptability on older adults with serious illness in the emergency department (ED). Upon demonstrating the intervention fidelity of this intervention in Part I, the investigators will collect patient-centered outcomes (Part II) of 100 older adults with serious illness after leaving the ED. Further in Part III, the investigators will conduct a survey to the participants' outpatient clinicians to find out how to optimize the care coordination from the ED to the outpatient office to facilitate advance care planning conversations.
Study Overview
Status
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02115
- Brigham and Women's Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Part 1.
Inclusion Criteria:
- ≥50 years of age AND ≥1 Serious illness* OR ED clinician would not be surprised if patient died in the next 12 months
- English-speaking
- Capacity to consent
Exclusion Criteria:
- Acute physical or emotional distress
- Determined by EM physician not to be appropriate
- Clearly documented goals for medical care** (Unless the treating clinician recommends that the patient needs the intervention)
- Delirium (assessed using 3D-CAM)
- Mild cognitive impairment or dementia (assessed using MiniCog or SBT)
- Already enrolled in this study
- Unable/unwilling to schedule the follow-up outcomes assessment on the calendar.
Part 2.
Inclusion Criteria:
- ≥50 years of age AND ≥1 Serious illness* OR ED clinician would not be surprised if patient died in the next 12 months
- English-speaking
- Patient with mild cognitive impairment or mild dementia with caregiver has a capacity to consent
- Caregivers of patients with moderate/severe dementia has a capacity to consent
Exclusion Criteria:
- Acute physical or emotional distress
- Determined by EM physician not to be appropriate
- Clearly documented goals for medical care** (Unless the treating clinician recommends that the patient needs the intervention)
- Delirium (assessed using 3D-CAM)
- Already enrolled in this study
- Unable/unwilling to schedule the follow-up outcomes assessment on the calendar.
(*NYHA Stage III/IV congestive heart failure, chronic obstructive lung disease on home oxygen, chronic kidney disease on dialysis, or metastatic solid tumor cancer. In addition, patients with NYHA Stage I/II congestive heart failure, chronic obstructive lung disease not on home oxygen, chronic kidney disease not on dialysis, solid tumor cancer without metastasis will be included if recent hospitalization in the last 12 months exists.) (**MOLST, medical order for life-sustaining treatment.)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: HEALTH_SERVICES_RESEARCH
- Allocation: NA
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Intervention Arm
This is a single-arm study with all enrolled patients receiving the same ED GOAL Nursing intervention
|
A brief (<7minutes) interview by an emergency department nurse to empower patients to formulate and communicate their goals for medical care with patients' outpatient clinicians.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Measurement of Intervention Fidelity
Time Frame: Immediately after the the intervention
|
Measure the intervention fidelity of ED GOAL Nursing administered by trained research nurses to seriously ill older adults or caregivers of patients with cognitive impairment in the ED (N=30).
Trained research nurses will demonstrate intervention fidelity >70% on a prespecified checklist.
|
Immediately after the the intervention
|
Measurement of change in ACP conversations before and after the intervention
Time Frame: Before and one month after the intervention
|
Conduct a pre-/post-intervention study (N=100) of ED GOAL Nursing on advance care planning (ACP) conversations one month (28 days) after leaving the ED (confirmed by EMR documentation of new/changes in ACP conversations, advance directive forms, or healthcare proxy, as well as changes in patient's or caregiver's self-reported ACP engagement).
≥25% of participants will have reported completing an ACP conversation, or changed advance directive forms or healthcare proxy, or change in patient's or caregiver's self-reported ACP engagement at one month after leaving the ED.
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Before and one month after the intervention
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Identification of key care coordination components from outpatient clinicians.
Time Frame: One month after the intervention
|
Conduct a survey on the outpatient clinicians of ED GOAL study participants one month (28 days) after the participating patients leave the ED to identify key care coordination components to maximize the intervention efficacy.
|
One month after the intervention
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient-reported ACP conversation after the intervention
Time Frame: One month after the intervention
|
Conduct a survey on the patients to ask if they report having new ACP conversation after the intervention.
The outcome is dichotomous (yes or no).
|
One month after the intervention
|
Documentation of new ACP in the electronic health records
Time Frame: Before and one month after the intervention
|
Conduct a chart review to find new documentation of advance care planning including new health care proxy form, new medical order for life-sustaining treatment, and new clinicians' free-text documentation of ACP conversations.
|
Before and one month after the intervention
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Kei Ouchi, Brigham and Women's Hospital
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2020P002934
- K76AG064434 (NIH)
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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