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Intervention to Improve Care at Life's End (BEACON)

23 april 2015 uppdaterad av: US Department of Veterans Affairs

Intervention to Improve Care at Life's End in VA Medical Centers

The BEACON trial (Best Practices for End-of-Life Care for Our Nations' Veterans) was a six-site implementation study to evaluate a multi-component, education-based intervention to improve the quality of end-of-life care provided in VA Medical Centers.

Studieöversikt

Status

Avslutad

Betingelser

Detaljerad beskrivning

The BEACON trial (Best Practices for End-of-Life Care for Our Nations' Veterans) was a six-site, real-world implementation trial of a multi-component, education-based intervention to improve the quality of end-of-life care conducted in VA Medical Centers (VAMCs).

The primary aim was to evaluate the effectiveness of a multi-component intervention for improving processes of care provided in the last days of life in VAMCs. The second aim was to conduct after-death interviews with next-of-kin and qualitative analysis of their perceptions of the care provided to the veteran and family.

The multi-component intervention targeted VAMC inpatient providers, including physician, nursing, and ancillary staff. It consisted of preparatory site visits, a staff training program, a newly developed Comfort Care order set decision support tool built into the CPRS, and follow-up consultation. The intervention team travelled to each site to conduct two weeks of comprehensive in-service training. Staff were trained to identify actively-dying patients and implement a set of best practices of traditionally home-based hospice care for dying patients. The team provided assistance with policies, procedures, and skill training needed to implement comfort care interventions. Introduction of the intervention at each VAMC was staggered across time at six-month intervals using a multiple-baseline, stepped wedge design.

Data on processes of end-of-life care (last 7 days) were abstracted from the CPRS medical records of all veterans who died before, during, and after the intervention (January 2005-February 2011). A priori, five processes of care were identified as primary endpoints to indicate quality of end-of-life care: 1) presence of an order for opioid pain medication at time of death; 2) a do-not-resuscitate (DNR) order in place at time of death; 3) location of death; 4) presence of enteral feeding tube or intravenous line at time of death; and 5) physical restraints in place at or near time of death.

In addition, in-depth, face-to-face interviews were conducted with 78 bereaved next-of-kin.

Studietyp

Interventionell

Inskrivning (Faktisk)

78

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

    • Alabama
      • Birmingham, Alabama, Förenta staterna, 35233
        • Birmingham VA Medical Center

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

  • Barn
  • Vuxen
  • Äldre vuxen

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  • Aim 1: Not applicable. Patients were deceased.
  • Aim 2: After-death interviews with next of kin: must be willing and able to participate in after-death interview at local VA Medical Center.

Exclusion Criteria:

  • N/A

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Hälsovårdsforskning
  • Tilldelning: N/A
  • Interventionsmodell: Enskild gruppuppgift
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: Arm 1
Comfort care education intervention, consisting of intensive, on-site staff training together with an electronic order set for palliative care and educational materials
Comfort care education intervention, consisting of intensive, on-site staff training together with an electronic order set for palliative care and educational materials

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Presence of Order for Opioid Pain Medication
Tidsram: Pre and Post Intervention
Presence of order for opioid pain medication at time of death based on abstraction of electronic medical record
Pre and Post Intervention

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Do Not Resuscitate Order
Tidsram: Pre and Post Intervention
Presence of a Do Not Resuscitate order at time of death based on abstraction of electronic medical record
Pre and Post Intervention
Number of Patients Who Died in ICU
Tidsram: Pre and Post Intervention
Location of death (ICU vs. other) based on abstraction of electronic medical record
Pre and Post Intervention
Individuals With a Nasogastric Tube
Tidsram: Pre and Post Intervention
Presence of nasogastric tube based on abstraction of electronic medical record
Pre and Post Intervention
Individuals With an Intravenous Line
Tidsram: Pre and Post Intervention
Presence of intravenous line infusing at time of death based on abstraction of electronic medical record
Pre and Post Intervention
Number of Individuals Who Died in Restraints
Tidsram: Pre and Post Intervention
Presence of restraints at or near time of death at time of death based on abstraction of electronic medical record
Pre and Post Intervention
Individuals Administered of Opioid Medication
Tidsram: Pre and Post Intervention
Administration of opioid medication based on abstraction of medical record
Pre and Post Intervention
Individuals With an Order for Antipsychotic Medication
Tidsram: Pre and Post Intervention
Order for antipsychotic medication based on abstraction of medical record
Pre and Post Intervention
Individuals Administered Antipsychotic Medication
Tidsram: Pre and Post Intervention
Administration of antipsychotic medication based on abstraction of medical record
Pre and Post Intervention
Individuals With an Order for Benzodiazepine Medication
Tidsram: Pre and Post Intervention
Order for benzodiazepine medication based on abstraction of medical record
Pre and Post Intervention
Individuals Who Received Benzodiazepine Medication
Tidsram: Pre and Post Intervention
Administration of benzodiazepine medication based on abstraction of medical record
Pre and Post Intervention
Individuals Who Received Scopolamine
Tidsram: Pre and Post Intervention
Administration of scopolamine (for death rattle) based on abstraction of medical record
Pre and Post Intervention
Sublingual Administration
Tidsram: Pre and Post Intervention
Sublingual administration of medication based on abstraction of medical record
Pre and Post Intervention
Individuals With Pastoral Care Visit
Tidsram: Pre and Post Intervention
Pastoral Care Visit based on abstraction of medical record
Pre and Post Intervention
Individuals With an Advance Directive
Tidsram: Pre and Post Intervention
Presence of advance directive based on abstraction of medical record
Pre and Post Intervention
Individuals With a Palliative Care Consultation
Tidsram: Pre and Post Intervention
Palliative Care Consultation based on abstraction of medical record
Pre and Post Intervention

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Utredare

  • Huvudutredare: Kathryn L Burgio, PhD MA BA, Birmingham, Alabama VA Medical Center

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 augusti 2005

Primärt slutförande (Faktisk)

1 mars 2011

Avslutad studie (Faktisk)

1 september 2013

Studieregistreringsdatum

Först inskickad

4 oktober 2005

Först inskickad som uppfyllde QC-kriterierna

4 oktober 2005

Första postat (Uppskatta)

6 oktober 2005

Uppdateringar av studier

Senaste uppdatering publicerad (Uppskatta)

27 april 2015

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

23 april 2015

Senast verifierad

1 april 2015

Mer information

Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .

Kliniska prövningar på Smärta

Kliniska prövningar på Comfort care education intervention

3
Prenumerera