Advanced Dementia and End-of-life

NCT ID: NCT03548142

Last Updated: 2019-04-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

38 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-07-11

Study Completion Date

2018-09-01

Brief Summary

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Palliative and hospice care in advanced dementia: experiences of care givers and benefit of a brochure serving as a decision-making aid

Aims:

1. Designing a brochure serving as an information tool and decision-making aid used to answer questions concerning palliative and hospice care for care-givers of persons with advanced dementia.

The brochure shall demonstrate the possibilities and offerings of palliative and hospice care and shall serve to inform about the advanced stages of dementia, the legal basic principles in decision making and ethical problems, treatment options and (palliative) treatment goals.
2. Survey of the palliative, palliative medical and hospice care of persons with advanced dementia in ambulatory settings, as well as in residential geriatric care and the experiences of the care-givers.

By examining persons with dementia and inspecting the care documents and where applicable the medical files it is to be evaluated:
* which procedures of palliative and hospice care are practically implemented in ambulatory care and in residential geriatric care,
* which symptoms the persons with dementia suffer from and how those symptoms are (or are not) treated,
* to what extend caregivers are informed about relevant aspects
* how caregivers assess care and which problems, needs and requests exist.
3. Piloting phase for the brochure. To test the comprehensibility and the acceptance of the brochure a study is planned. The caregivers are asked for their opinion whether the brochure is helpful. It is recorded if the reading of the brochure gets the caregivers to engage actively in the participative decision making process.

Detailed Description

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Two visits at home or in the residential geriatric care at intervals of eight to twelve weeks are scheduled.

The following data is collected at enrollment:

* Informed consent of the caregiver and of the patient or rather the caregiver with powers of attorney
* Sociodemographic data (caregiver and person with dementia), e.g. age, sex, education, degree of relationship
* Interview of the caregiver using standardized
* Examination of the person with dementia, recording of the treatment and the care situation, cognitive status: Mini-Mental-Status-Test, severity of dementia: Clinical Dementia Rating Scale, performance in basic activities of daily living: Barthel-Index,communication competence, diagnosis, (palliative) medical and hospice care (including specialists in palliative care, specialists in hospice care, general practioners, domiciliary care services, Allgemeine Ambulante Palliativversorgung \[AAPV\], Spezielle Ambulante Palliativversorgung \[SAPV\], AAPV and SAPV both being a specific ambulatory palliative care of the statutory health insurance system in Germany, cognitive/neurological/physical symptoms, symptom Management including pharmacological and non-pharmacological treatment, interventions, existence and phrasing of advanced directives and durable power of attorney.

After enrollment the brochure is handed and explained to the caregivers and they are encouraged to read it. It is pointed out that they are contacted after two to three months to answer questions concerning comprehensibility, acceptance, practical consequences and to give a personnel review.

At study end after two to three months standardized interviews are conducted to gather information about comprehensibility and acceptance of the brochure, how it is reviewed by the caregivers and if the reading had direct consequences with regard to knowledge of the caregiver, communicating with nursing staff/physicians, decision making and implementing those decisions.

Conditions

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Advanced Dementia

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Interventions

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provision of relevant information

caregivers are provided with brochure that informs about end-of-life issues for persons with advanced dementia

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Person with dementia + caregiver live in the Munich area
* Person with dementia lives in a nursing home or at home
* Person with dementia is in an advanced stage of the disease (moderate to severe dementia)
* Informed consent of the caregiver and the person with powers of attorney
* Caregiver is German-speaking and able to read
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Bavarian State Ministry of Health and Care

OTHER_GOV

Sponsor Role collaborator

German Alzheimer Society

OTHER

Sponsor Role collaborator

Technical University of Munich

OTHER

Sponsor Role lead

Responsible Party

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Janine Diehl-Schmid

Clinical Professor, Principle Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Center for Cognitive Disorders

Munich, Bavaria, Germany

Site Status

Countries

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Germany

References

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Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. doi: 10.1016/0022-3956(75)90026-6. No abstract available.

Reference Type BACKGROUND
PMID: 1202204 (View on PubMed)

Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993 Nov;43(11):2412-4. doi: 10.1212/wnl.43.11.2412-a. No abstract available.

Reference Type BACKGROUND
PMID: 8232972 (View on PubMed)

MAHONEY FI, BARTHEL DW. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965 Feb;14:61-5. No abstract available.

Reference Type BACKGROUND
PMID: 14258950 (View on PubMed)

Lerman CE, Brody DS, Caputo GC, Smith DG, Lazaro CG, Wolfson HG. Patients' Perceived Involvement in Care Scale: relationship to attitudes about illness and medical care. J Gen Intern Med. 1990 Jan-Feb;5(1):29-33. doi: 10.1007/BF02602306.

Reference Type BACKGROUND
PMID: 2299426 (View on PubMed)

Vohra JU, Brazil K, Hanna S, Abelson J. Family Perceptions of End-of-Life Care in long-term care facilities. J Palliat Care. 2004 Winter;20(4):297-302.

Reference Type BACKGROUND
PMID: 15690832 (View on PubMed)

Biola H, Sloane PD, Williams CS, Daaleman TP, Williams SW, Zimmerman S. Physician communication with family caregivers of long-term care residents at the end of life. J Am Geriatr Soc. 2007 Jun;55(6):846-56. doi: 10.1111/j.1532-5415.2007.01179.x.

Reference Type BACKGROUND
PMID: 17537084 (View on PubMed)

Ryan RE, Connolly M, Bradford NK, Henderson S, Herbert A, Schonfeld L, Young J, Bothroyd JI, Henderson A. Interventions for interpersonal communication about end of life care between health practitioners and affected people. Cochrane Database Syst Rev. 2022 Jul 8;7(7):CD013116. doi: 10.1002/14651858.CD013116.pub2.

Reference Type DERIVED
PMID: 35802350 (View on PubMed)

Riedl L, Bertok M, Hartmann J, Fischer J, Rossmeier C, Dinkel A, Ortner M, Diehl-Schmid J. Development and testing of an informative guide about palliative care for family caregivers of people with advanced dementia. BMC Palliat Care. 2020 Mar 12;19(1):30. doi: 10.1186/s12904-020-0533-3.

Reference Type DERIVED
PMID: 32164707 (View on PubMed)

Other Identifiers

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palliative study

Identifier Type: -

Identifier Source: org_study_id

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