Integrated Multidisciplinary Patient and Family Advance Care Planning Trial

NCT ID: NCT03609658

Last Updated: 2021-08-06

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

146 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-11-02

Study Completion Date

2019-12-10

Brief Summary

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The purpose of this study is to compare ways to engage sick patients and their family members in Advance Care Planning (ACP) discussions. Two pathways will be tested, discussions using a Nurse Navigator led pathway versus usual care.

Detailed Description

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This study is a randomized, pragmatic, comparative effectiveness trial for determining better ways to engage multimorbid patients and their family members in Advance Care Planning through a Nurse Navigator led pathway versus usual care. Investigators propose to utilize Zelen's design (a more recent label/generalization for this type of design is the cohort multiple randomized controlled trial (cmRCT), a pragmatic clinical trial design whereby all participants are randomized prior to informed consent, and then only patients randomized to the interventional arm are approached for consent and subsequently enrolled in the intervention group.

Conditions

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Advance Care Planning

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

There are two groups. All participants are randomized prior to informed consent, and then only patients randomized to the interventional arm are approached for consent and subsequently enrolled in the intervention group. Note that patients that do not consent to the intervention are still counted as part of control group under an intent-to-treat paradigm, which necessitates passive ascertainment mechanisms for outcomes (i.e. administrative claims or the EHR).
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Nurse Navigator Pathway Group

Participants in this Nurse Navigator led ACP pathway group will participate in ACP discussions, surveys, and participant visit(s) for duration of the study (12 months)

Group Type EXPERIMENTAL

Nurse Navigator Pathway

Intervention Type BEHAVIORAL

In the Nurse Navigator Pathway, nurse navigators are being used as leverage to: approach qualified patients to initiate advance care planning discussions, schedule advance care planning visit with patients' primary care provider to further discuss advance care planning and to mail advance care planning resources to patients after their initial advance care planning discussion.

Usual Care Group

Participants in the Usual Care group will follow usual daily living activities for the duration of the study (12 months).

Group Type SHAM_COMPARATOR

Usual Care

Intervention Type BEHAVIORAL

In the Usual Care arm, there is no approach by nurse navigators to initiate advance care planning discussions and it does not have a structure advance care planning visit. Therefore, no further action is required for the patients who were randomly assigned to the usual care arm.

Interventions

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Nurse Navigator Pathway

In the Nurse Navigator Pathway, nurse navigators are being used as leverage to: approach qualified patients to initiate advance care planning discussions, schedule advance care planning visit with patients' primary care provider to further discuss advance care planning and to mail advance care planning resources to patients after their initial advance care planning discussion.

Intervention Type BEHAVIORAL

Usual Care

In the Usual Care arm, there is no approach by nurse navigators to initiate advance care planning discussions and it does not have a structure advance care planning visit. Therefore, no further action is required for the patients who were randomly assigned to the usual care arm.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Aged 65 or older patient within the Wake Forest/Cornerstone ACO
* Have seen their primary care provider within the Wake Forest/Cornerstone network in the past 12 months
* English speaking
* No documented Advance Directive in the EHR
* Impairments in either physical function, cognition, and/or frailty

Exclusion Criteria

* No available proxy (e.g. in setting of cognitive impairment)
* Severe/advanced dementia
* Moderate to severe hearing loss
* Non-English speaking
* No phone number available for patient
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Duke University

OTHER

Sponsor Role collaborator

Wake Forest University Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jennifer Gabbard, MD

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Locations

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Family & Community Medicine of Asheboro

Asheboro, North Carolina, United States

Site Status

Claremont Family Medicine

Claremont, North Carolina, United States

Site Status

Conover Family Practice

Conover, North Carolina, United States

Site Status

Chronic Complex Care

High Point, North Carolina, United States

Site Status

Cornerstone Internal Medicine at Westchester

High Point, North Carolina, United States

Site Status

High Point Family Practice

High Point, North Carolina, United States

Site Status

Thomasville Family Practice

Thomasville, North Carolina, United States

Site Status

Downtown Health Plaza

Winston-Salem, North Carolina, United States

Site Status

Wake Forest University Health Sciences

Winston-Salem, North Carolina, United States

Site Status

Countries

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United States

References

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Reference Type DERIVED
PMID: 33427851 (View on PubMed)

Gabbard J, Pajewski NM, Callahan KE, Dharod A, Foley K, Ferris K, Moses A, Grey C, Williamson J. Advance care planning for vulnerable older adults within an Accountable Care Organization: study protocol for the IMPACT randomised controlled trial. BMJ Open. 2019 Dec 15;9(12):e032732. doi: 10.1136/bmjopen-2019-032732.

Reference Type DERIVED
PMID: 31843844 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

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Document Type: Informed Consent Form

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Other Identifiers

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IRB00049370

Identifier Type: -

Identifier Source: org_study_id

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