Palliative Care in People Living With HIV/AIDS: Integrating Into Standard of Care (FACE)
Our goal is to advance palliative care with persons living with AIDS (PLWA) or life-limiting co-morbidities to decrease suffering and increase quality of life (QOL). Left without advance care planning (ACP) for end-of-life decision, miscommunication and disagreements may result in families being charged with neglect or court battles over treatment choices, unmet care or delivery of unnecessary or unwanted care, and non-relative caregivers being dismissed (e.g. gay partners). We hope to increase families' understandings of their family member's wishes for end-of-life care to decrease conflict through the FAmily-CEntered Advance (FACE) Care Planning intervention. We will also study communication, quality of life, and spiritual struggle. Families will be randomized into either the Control (N=96 families) or the FACE Intervention (n=192 dyads). FACE families will meet with a trained/certified researcher for two 60-minute sessions scheduled one week apart: Session 1: The Respecting Choices Interview®; and Session 2: Completion of The Five Wishes©. Control families will also meet with a researcher for two 60-minute sessions scheduled one week apart: Session 1: Developmental History; and Session 2: Nutrition and Exercise. Questionnaires will be administered five times, Baseline and at 3, 6, 12 and 18 month post-intervention, for an average of 2 years.
AIM 1. To determine the efficacy of FACE on congruence in treatment preferences between PLWA and their surrogates over time, and the effect of the pattern of congruence development trajectory on healthcare utilization (i.e., distal outcomes: number of hospitalizations, dialysis, ER visits).
Hypothesis A: Development of congruence may not be homogeneous and FACE may influence the pattern of congruence development.
Hypothesis B: Different patterns of congruence development may have different effects on health care utilization.
Hypothesis C: Compared to Controls, FACE participants will better maintain congruence over time.
AIM 2. To determine the efficacy of FACE on key components of QOL for PLWA. Hypothesis: FACE participants will increase or better maintain psychosocial QOL compared to Controls.
AIM 3. To minimize health disparities in ACP between Blacks and non Blacks and identify factors associated with disparities.
Hypothesis: Blacks in the FACE intervention will complete advance directives at a rate comparable to non Blacks, and at significantly greater rates compared to Controls.
研究概览
详细说明
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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District of Columbia
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Washington、District of Columbia、美国、20010
- Children's National Medical Center
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Washington、District of Columbia、美国、20037
- George Washington University
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Washington、District of Columbia、美国、20007
- Georgetown University Hospital
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Washington、District of Columbia、美国、20010
- Institute for Clinical Research, Inc. (Affiliated with Department of Veterans Affairs Medical Center of Washington, DC)
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Washington、District of Columbia、美国、20010
- MedStar Health Research Institute/Washington Hospital Center
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Patient Inclusion Criteria:
- HIV positive outpatients or inpatients with detectable viral load (>200 copies) twice in the past 1 year period OR CD4 count <200 OR with a co-morbidity that may significantly limit life expectancy, including malignancy, cirrhosis, cardiomyopathy, etc.
- Patients with AIDS receiving dialysis, inpatients or outpatients
- Patients not in the Intensive Care Unit (ICU)
- Age 21 years or older
- All ethnic groups
- Male or female
- Knows his/her HIV status
- English speaking
- Absence of active psychosis or homicidal or suicidal ideation, determined at baseline screening by a trained research assistant as assessed by questions from a structured questionnaire
- Absence of HIV dementia, determined at screening using the HIV Dementia Scale cut off score of <10
- No evidence of developmental delay
- Consent from surrogate
- Consent from persons living with AIDS (PLWA) aged 21 or older
Surrogate Decision-maker inclusion criteria:
- Selected by patient
- Age 18 or older
- Willingness to discuss problems related to HIV and End Of Life (EOL)
- Absence of active psychosis, homicidal ideation, or suicidal ideation determined at baseline screening by trained RA
- Absence of HIV dementia, determined at screening using the HIV Dementia Scale cut off score of <10
- English speaking
- Consent to participate
- Knows HIV status of patient
Patient Exclusion Criteria:
- Patients in the ICU
- Age under 21 years old
- Patient unaware of HIV status
- Active psychosis or homicidal or suicidal ideation, determined at baseline screening by a trained research assistant as assessed by questions from a structured questionnaire
- Presence fo HIV Dementia at baseline
- Developmental delay
- Unable to find willing consented surrogate
Surrogate Decision-maker Exclusion Criteria:
- Surrogate under age of 18 years old
- Unwilling to discuss problems related to HIV and EOL
- Active psychosis or homicidal or suicidal ideation, determined at baseline screening by a trained research assistant as assessed by questions from a structured questionnaire
- Not an English speaker
- Unwilling to consent to participate and does not know HIV status of patient
学习计划
研究是如何设计的？
设计细节
- 主要用途：支持治疗
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：单身的
武器和干预
参与者组/臂 |
干预/治疗 |
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有源比较器：Healthy Living Control
Two-60 to 90 minute sessions scheduled one week apart. Session 1: Developmental History: Goal: To take a non-medical developmental history. The Research Assistant (RA)-Control will conduct the session in a structured interview format. Administered with all medical questions removed to prevent any risk of contamination with the experimental condition. Session 2: Nutrition and Exercise: Assess nutritional status and provide advice for maintaining optimal nutrition to boost immune functioning. Administered by the RA Control and will be videotaped to control for what occurs in the FACE intervention. |
Two-60 to 90 minute sessions scheduled one week apart. Session 1: Respecting Choices Interview (R)to facilitate conversations and shared decision-making between the patient and surrogate about palliative care & prepare the surrogate to be able to fully represent the patient's wishes. Session 2: Five Wishes (C). Patient selects which person the patient wants to make health care decisions for him/her; the kind of medical treatment the patient wants; how comfortable the patient wants to be; how the patient wants people to treat him/her; what patient wants loved ones to know; and any spiritual or religious concerns the patient may have.
其他名称：
Session 1: Developmental History: Goal: To take a non-medical developmental history. The RA-Control will conduct the session in a structured interview format. Administered with all medical questions removed to prevent any risk of contamination with the experimental condition. Session 2: Nutrition and Exercise: Assess nutritional status and provide advice for maintaining optimal nutrition to boost immune functioning. Administered by the RA Control and will be videotaped to control for what occurs in the FACE intervention.
其他名称：
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实验性的：FAmily-CEntered Advance Care Planning
Two-60 to 90 minute sessions scheduled one week apart. Session 1: Respecting Choices Interview (R)to facilitate conversations and shared decision-making between the patient and surrogate about palliative care & prepare the surrogate to be able to fully represent the patient's wishes. Session 2: Five Wishes (C). Patient selects which person the patient wants to make health care decisions for him/her; the kind of medical treatment the patient wants; how comfortable the patient wants to be; how the patient wants people to treat him/her; what patient wants loved ones to know; and any spiritual or religious concerns the patient may have. |
Two-60 to 90 minute sessions scheduled one week apart. Session 1: Respecting Choices Interview (R)to facilitate conversations and shared decision-making between the patient and surrogate about palliative care & prepare the surrogate to be able to fully represent the patient's wishes. Session 2: Five Wishes (C). Patient selects which person the patient wants to make health care decisions for him/her; the kind of medical treatment the patient wants; how comfortable the patient wants to be; how the patient wants people to treat him/her; what patient wants loved ones to know; and any spiritual or religious concerns the patient may have.
其他名称：
Session 1: Developmental History: Goal: To take a non-medical developmental history. The RA-Control will conduct the session in a structured interview format. Administered with all medical questions removed to prevent any risk of contamination with the experimental condition. Session 2: Nutrition and Exercise: Assess nutritional status and provide advice for maintaining optimal nutrition to boost immune functioning. Administered by the RA Control and will be videotaped to control for what occurs in the FACE intervention.
其他名称：
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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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Statement of Treatment Preferences
大体时间：Baseline and 3, 6, 12, 18 month post-intervention
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Measured by the Statement of Treatment Preferences.
This measure was adapted using experts and community advisory board.
It is a tool to express values and goals related to future medical decisions regarding frequently occurring situations specific to HIV/AIDS.Multiple Time Frames are needed as the Primary Outcome measure is going to report a change over time, per Aim 1: "to sustain congruence in treatment preferences between PLWA and their surrogate over time" compared to controls.
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Baseline and 3, 6, 12, 18 month post-intervention
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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Lyon Advance Care Planning Survey (Patient and Surrogate Version)
大体时间：at baseline
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A 31-item instrument that assesses palliative care needs of PLWA of Black and non Black PLWA in DC metropolitan area
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at baseline
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Palliative Care Outcome Scale (POS)
大体时间：Baseline, and 3, 6, 12 and 18 month post-intervention
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This scale is a valid and reliable measure of patient's current health, social and psychological status.We are conducting a longitudinal study and therefore looking at multiple time frames for change in palliative care over time.
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Baseline, and 3, 6, 12 and 18 month post-intervention
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Medical Outcomes Study-HIV (MOS-HIV)
大体时间：Baseline, and 3, 6, 12 and 18 month post-intervention
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Measures HIV specific Health Related Quality of Life; general health perceptions; pain; physical, role, cognitive and social functioning; mental health; energy/fatigue; health distress and quality of life.
This is a longitudinal study requiring multiple time frames so we can report change in quality of life over time, related to HIV specific symptoms.
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Baseline, and 3, 6, 12 and 18 month post-intervention
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其他结果措施
结果测量 |
措施说明 |
大体时间 |
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HIV Dementia Scale
大体时间：Screen for eligibility at Baseline, 3, 6, 12 and 18 months post intervention
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Rapid screener to identify HIV dementia, which is an exclusion criteria.
However, once enrolled in the study we will track changes in status over time, per the longitudinal nature of this study.
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Screen for eligibility at Baseline, 3, 6, 12 and 18 months post intervention
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Psychological Interview
大体时间：Baseline to screen to determine eligibility
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Questions to screen for homicidality and psychosis
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Baseline to screen to determine eligibility
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Patient Health Questionnaire (PHQ-9)
大体时间：Baseline screening to determine if eligible for participation, then at 3, 6, 12 and 18 month post-intervention follow-up
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Patients or surrogates who present with severe depression or suicidality are excluded from this study.
However, once enrolled levels of depressive symptoms will be monitored over the course of this longitudinal study.
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Baseline screening to determine if eligible for participation, then at 3, 6, 12 and 18 month post-intervention follow-up
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Medication Adherence Self Report Inventory (MASRI)
大体时间：Baseline and 3, 6, 12 and 18 month follow-up
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Validated self-report measure of medication adherence, using the Visual Analogue Scale for estimated adherence in the past month.
Measured multiple times as part of this longitudinal study.
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Baseline and 3, 6, 12 and 18 month follow-up
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Brief Multidimensional Measurement of Religiousness/Spirituality (BMMRS-adapted)
大体时间：Baseline and 3, 6, 12 and 18-month post intervention
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Assesses the construct of spiritual functioning, specifically subscales for Forgiveness, Values and Believes will be used for study purposes.
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Baseline and 3, 6, 12 and 18-month post intervention
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Brief Religious Coping Questionnaire (Brief RCOPE)
大体时间：Baseline and 3, 6, 12 and 18-month post-intervention
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Assesses positive and negative religious coping methods.
Study will use 14-item version.
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Baseline and 3, 6, 12 and 18-month post-intervention
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Satisfaction Scale
大体时间：Immediately following Session 1 and Session 2, week 2 and week 3 of the study
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Process measure developed in pilot study to assess satisfaction.
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Immediately following Session 1 and Session 2, week 2 and week 3 of the study
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Longitudinal Satisfaction Questionnaire
大体时间：3, 6, 12 and 18 month post-intervention
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Process measure to assess longitudinal satisfaction with future decision making.
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3, 6, 12 and 18 month post-intervention
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Medical Chart Abstraction
大体时间：Baseline and 3, 6, 12 and 18 month post intervention
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Mode of transmission, Cluster of Differentiation 4 (CD4) count, viral load, hospitalization, emergency room visit or dialysis since last study visit.
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Baseline and 3, 6, 12 and 18 month post intervention
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Threat Appraisal Scale (TAS)
大体时间：Baseline, 3, 6, 12 and 18 month post-intervention
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Threat Appraisal Scale (TAS)is a questionnaire administered to the adolescent during baseline assessment only.
This measure will retrospectively estimate the adolescent's threat appraisal of cancer when adolescent learned of cancer diagnosis.
Test-retest reliability for this measure ranges from .68 in younger children to .93 in older children.
TAS scores are found to demonstrate a high degree of agreement with children's open-ended descriptions of negative life events, indicating adequate convergent validity of this measure.
Theoretically, threat appraisal is related to Lazarus' concept of primary appraisal, particularly to the way in which the event threatens the child's commitments, goals, or values.
Higher threat appraisals should lead to negative arousal and coping and to increased psychological symptoms.
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Baseline, 3, 6, 12 and 18 month post-intervention
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合作者和调查者
合作者
调查人员
- 首席研究员：Maureen E Lyon, PhD、Children's National Research Institute
出版物和有用的链接
一般刊物
- Kimmel AL, Wang J, Scott RK, Briggs L, Lyon ME. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers. Contemp Clin Trials. 2015 Jul;43:172-8. doi: 10.1016/j.cct.2015.06.003. Epub 2015 Jun 2.
- Lyon ME, Squires L, D'Angelo LJ, Benator D, Scott RK, Greenberg IH, Tanjutco P, Turner MM, Weixel TE, Cheng YI, Wang J. FAmily-CEntered (FACE) Advance Care Planning Among African-American and Non-African-American Adults Living With HIV in Washington, DC: A Randomized Controlled Trial to Increase Documentation and Health Equity. J Pain Symptom Manage. 2019 Mar;57(3):607-616. doi: 10.1016/j.jpainsymman.2018.11.014. Epub 2018 Nov 23.
- Curtin KB, Cheng YI, Wang J, Scott RK, Squires L, Benator DA, Lyon ME; Palliative Care Consortiums. Quality of life of persons living with HIV and congruence with surrogate decision-makers. Qual Life Res. 2019 Jan;28(1):47-56. doi: 10.1007/s11136-018-2002-5. Epub 2018 Sep 15.
- Lyon ME, Squires L, Scott RK, Benator D, Briggs L, Greenberg I, D'Angelo LJ, Cheng YI, Wang J. Effect of FAmily CEntered (FACE(R)) Advance Care Planning on Longitudinal Congruence in End-of-Life Treatment Preferences: A Randomized Clinical Trial. AIDS Behav. 2020 Dec;24(12):3359-3375. doi: 10.1007/s10461-020-02909-y.
- Grill KB, Wang J, Cheng YI, Lyon ME. The Role of Religiousness and Spirituality in Health-related Quality of Life of Persons Living with HIV: A Latent Class Analysis. Psycholog Relig Spiritual. 2020 Nov;12(4):494-504. doi: 10.1037/rel0000301. Epub 2020 Jan 30.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他相关的 MeSH 术语
其他研究编号
- 1R01NR01405201
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)？
IPD 计划说明
IPD 共享时间框架
IPD 共享访问标准
Researchers or graduate students in need of a master's theses or dissertation project from academic settings, e.g. university or academic/research hospital will be allowed to have access to de-identified data.
Contact the PI Dr. Lyon at mlyon@childrensnational.org.
IPD 共享支持信息类型
- 研究方案
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.
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Hospital Clinic of Barcelona完全的
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Centers for Disease Control and PreventionGilead Sciences; CDC Foundation完全的
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Rajavithi Hospital未知研究在放疗前和放疗最后一周接受放疗的 HIV 癌症患者的免疫状态 | 研究在放疗前和放疗最后一周接受放疗的 HIV 癌症患者的 HIV 病毒载量泰国
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National Institute of Allergy and Infectious Diseases...完全的HIV-1 感染 | HIV抗体 | 中和抗体 | 病毒载量 | 单克隆抗体美国
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AIDS Healthcare FoundationUniversity of California, Los Angeles完全的
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ANRS, Emerging Infectious DiseasesInstitut National de la Santé Et de la Recherche Médicale, France; University of Bergen; Centre... 和其他合作者完全的
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Hospital Universitari Vall d'Hebron Research InstituteGilead Sciences完全的
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Hospital Universitari Vall d'Hebron Research InstituteUniversity Hospital, Ghent; IrsiCaixa完全的