Denna sida har översatts automatiskt och översättningens korrekthet kan inte garanteras. Vänligen se engelsk version för en källtext.

iLIVE Medication Study (iLIVEmed)

18 januari 2021 uppdaterad av: Prof. dr. Stefan Sleijfer

Towards Medication Optimisation in the Last Phase of Life: iLIVE Medication Study

The iLIVE medication study is a before-after study where medication optimisation of patients with an estimated life expectancy of six months is investigated. The investigators will include 400 patients in 3 countries. The primary outcome is an assessment of the quality of life of patients, four weeks after baseline assessment

Studieöversikt

Status

Har inte rekryterat ännu

Betingelser

Intervention / Behandling

Detaljerad beskrivning

Rationale: Patients in the last phase of life often use many medications until shortly before they die. This is partly inevitable, because these patients often experience multiple distressing symptoms. However, for a considerable number of medications currently often used at the end of life, the benefit is debatable, e.g. because they are aimed at the long-term prevention of illness.

Objective: the primary objective is to examine whether the use of a clinical decision support system (CDSS-OPTIMED), a personalized medication advice to attending physicians of patients in the last phase of life, contributes to patients' quality of life.

Main study endpoints: the primary outcome is an assessment of the quality of life of patients, four weeks after baseline assessment

Potential risks and benefits associated with participation: the intervention in the medication study supports physicians in using available evidence and knowledge when prescribing or deprescribing medication for patients in the last phase of life. The intervention does not involve experimental treatment or medication. The investigators expect no other risks than known side effects of (stopping) medications. The investigators are aware that the study population concerns vulnerable people who may experience fluctuating symptoms and levels of suffering across their disease trajectory. The investigators acknowledge the risk of overburdening participants. If patients feel burdened by participating in the study, they are encouraged to indicate that.

Studietyp

Interventionell

Inskrivning (Förväntat)

400

Fas

  • Inte tillämpbar

Kontakter och platser

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

Studiekontakt

Studera Kontakt Backup

Studieorter

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

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion criteria for patients:

  1. Patient is 18 years or over and provides informed consent to participate.
  2. The patient is aware that recovering from his/her disease is unlikely, as assessed by the attending physician.
  3. The patient agrees to participate in the iLIVE cohort study.
  4. The attending physician would not be surprised if the patient would die within 6 months ('Surprise question').
  5. If the physician is uncertain about the surprise question, the patient is eligible if presenting with at least one SPICT indicator. The SPICT™ is a tool to help professionals identify people with general indicators of poor or deteriorating health and clinical signs of life-limiting conditions for assessment and care planning, based on general or disease-specific indicators.

Inclusion criteria for relative/informal caregiver of included patients:

Relatives of included patients are asked to participate if they are: 18 years or over and provide informed consent to participate; aware that it is unlikely that the patient will recover from his/her disease; and capable of filling in a questionnaire in the country's main language or in English.

Exclusion Criteria:

  1. The patient is incapable of filling in a questionnaire in the country's main language or in English (patients may be supported by relatives when filling in the questionnaire).
  2. The attending physician makes the decision that the patient should not be included in the study due to e.g. illness burden, fast deterioration or imminent death, lack of trusting relationship with the physician.

Studieplan

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

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Stödjande vård
  • Tilldelning: Icke-randomiserad
  • Interventionsmodell: Sekventiell tilldelning
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Inget ingripande: Control arm
Patients in the control arm will receive the usual treatment
Experimentell: Intervention arm
After crossing over to the intervention period, attending physicians will receive medication alerts from the Clinical Decision Support System (CDSS) within 1 week after inclusion of the patient. The medication alerts will be sent to the physician's email address. The physician is free to follow or ignore the advice in the alerts. If the physicians thinks these alerts are relevant for the patient, the physician will discuss these alerts with the patient and/or relatives. After this conversation, the physician will prescribe or deprescribe medications based on the alerts.
Enhet: CDSS-OPTIMED
The CDSS-OPTIMED is a software program that provides the physician with a personalized alert on whether to consider stopping or starting medication for a specific patient.

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Patients' quality of life
Tidsram: 4 weeks after baseline assessment
measured by the EORTC QLQ-C15-PAL QoL question
4 weeks after baseline assessment

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Patients' symptoms
Tidsram: 4 weeks after baseline assessment
measured by the ESAS
4 weeks after baseline assessment
Use of medication of the patient
Tidsram: 4 weeks after baseline assessment
measured by the medical file data and pharmacist's information system
4 weeks after baseline assessment
Patient survival
Tidsram: From inclusion until death if patients die within the study period. If patient do not die within the study period, they will be followed up to a maximum of the full study period, i.e. a period of 2 years after start of the study
measured by the time between inclusion until death
From inclusion until death if patients die within the study period. If patient do not die within the study period, they will be followed up to a maximum of the full study period, i.e. a period of 2 years after start of the study
Satisfaction of the patient and relative with medication
Tidsram: 4 weeks after baseline assessment
measured by the TSQM-9
4 weeks after baseline assessment
Satisfaction of the attending physician with the CDSS-OPTIMED
Tidsram: 4 weeks after baseline assessment
measured by a self-developed questionnaire
4 weeks after baseline assessment
Episodes of symptomatic hypertension/hypotension/hyperglycaemia/hypoglycaemia and thrombo-embolic complications or bleeding events of the patient
Tidsram: If patients die within 6 months after inclusion, data will be collected retrospectively from baseline until death. If patients live longer than 6 months, data will be collected retrospectively from baseline until 6 months after baseline
collected via medical file data, using a pre-structured checklist
If patients die within 6 months after inclusion, data will be collected retrospectively from baseline until death. If patients live longer than 6 months, data will be collected retrospectively from baseline until 6 months after baseline
Socio-demographic characteristics of the patient
Tidsram: Baseline
Age, gender, current living situation, education, nationality, religion, socioeconomic status
Baseline

Andra resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Development and training costs of the intervention
Tidsram: Retrospectively over full study period, i.e. a period of 2 years
Based on proformas completed by the developers and the study personnel
Retrospectively over full study period, i.e. a period of 2 years
Operational costs of the intervention
Tidsram: Retrospectively over full study period, i.e. a period of 2 years
Based on time spent on discussing medication alerts with the pharmacist and patient/relative and time registrations via automated system extracts
Retrospectively over full study period, i.e. a period of 2 years
Patients' use of medical interventions
Tidsram: If patients die within 6 months after inclusion, data will be collected retrospectively from baseline until death. If patients live longer than 6 months, data will be collected retrospectively from baseline until 6 months after baseline
Measured by using a pre-structured checklist. Items to be assessed include: place of care, medical events and complications, medication use, medical and surgical interventions, goals of care statements, resuscitation policy, non-treatment decisions
If patients die within 6 months after inclusion, data will be collected retrospectively from baseline until death. If patients live longer than 6 months, data will be collected retrospectively from baseline until 6 months after baseline
Costs of medical care
Tidsram: If patients die within 6 months after inclusion, data will be collected retrospectively from baseline until death. If patients live longer than 6 months, data will be collected retrospectively from baseline until 6 months after baseline
Measured by using a pre-structured checklist. Items to be assessed include: place of care, medical events and complications, medication use, medical and surgical interventions, goals of care statements, resuscitation policy, non-treatment decisions
If patients die within 6 months after inclusion, data will be collected retrospectively from baseline until death. If patients live longer than 6 months, data will be collected retrospectively from baseline until 6 months after baseline
Patients' health related quality of life
Tidsram: 4 weeks after baseline assessment
measured by the EQ-5D-5L
4 weeks after baseline assessment
Patients' capabilities
Tidsram: 4 weeks after baseline assessment
measured by the ICECAP-SCM
4 weeks after baseline assessment
Patients' resource use, employment and patient activities/informal care needs
Tidsram: 4 weeks after baseline assessment
measured by the HEQ
4 weeks after baseline assessment
Relatives' health related quality of life
Tidsram: 4 weeks after baseline assessment
measured by the EQ-5D-5L
4 weeks after baseline assessment
Relatives' capabilities
Tidsram: 4 weeks after baseline assessment
measured by the ICECAP-CPM
4 weeks after baseline assessment
Relatives' informal care provision
Tidsram: 4 weeks after baseline assessment
measured by the partial IVICQ and CIIQ
4 weeks after baseline assessment
Dutch subgroup patients' health related quality of life
Tidsram: 8 weeks after baseline assessment, repeated 4-weekly to a maximum of 24 weeks
measured by the EQ-5D-5L
8 weeks after baseline assessment, repeated 4-weekly to a maximum of 24 weeks
Dutch patients' capabilities
Tidsram: 8 weeks after baseline assessment, repeated 4-weekly to a maximum of 24 weeks
measured by the ICECAP-SCM
8 weeks after baseline assessment, repeated 4-weekly to a maximum of 24 weeks
Dutch patients' resource use, employment and patient activities/informal care needs
Tidsram: 8 weeks after baseline assessment, repeated 4-weekly to a maximum of 24 weeks
measured by the HEQ
8 weeks after baseline assessment, repeated 4-weekly to a maximum of 24 weeks

Samarbetspartners och utredare

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

Sponsor

Prof. dr. Stefan Sleijfer

Samarbetspartners

Lund University
Medical University of Vienna
Landspitali University Hospital

Utredare

  • Huvudutredare: Karin van der Rijt, PhD, Erasmus MC

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 (Förväntat)

15 januari 2021

Primärt slutförande (Förväntat)

15 januari 2023

Avslutad studie (Förväntat)

15 januari 2024

Studieregistreringsdatum

Först inskickad

7 januari 2021

Först inskickad som uppfyllde QC-kriterierna

18 januari 2021

Första postat (Faktisk)

22 januari 2021

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

22 januari 2021

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

18 januari 2021

Senast verifierad

1 januari 2021

Mer information

Termer relaterade till denna studie

Nyckelord

Andra studie-ID-nummer

  • NL72473.078.20

Plan för individuella deltagardata (IPD)

Planerar du att dela individuella deltagardata (IPD)?

Ja

Läkemedels- och apparatinformation, studiedokument

Studerar en amerikansk FDA-reglerad läkemedelsprodukt

Nej

Studerar en amerikansk FDA-reglerad produktprodukt

Nej

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 .

Prenumerera