EFFICACY: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning by Hospitalists

Study Results

Results available

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

View full results

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

163 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-07-01

Study Completion Date

2021-08-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Hopewell Hospitalist is a theory-based adventure video game designed to increase the likelihood that a physician will engage in an advance care planning (ACP) conversation with a patient over the age of 65. Drawing on the theory of narrative engagement, players assume the persona of a hospitalist and navigate a series of clinical encounters with seriously-ill patients over the age of 65. Players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a pragmatic stepped-wedge crossover phase III trial testing the efficacy of Hopewell Hospitalist for increasing ACP rates measured by ACP billing frequency.

Related Clinical Trials

Explore similar clinical trials based on study characteristics and research focus.

EFFECTIVENESS: Hopewell Hospitalist: A Video Game Intervention to Increase Advance Care Planning by Hospitalists

NCT04881968

Advance Care Planning

TERMINATED NA

Project Talk Trial: Engaging Underserved Communities in End-of-life Conversations

NCT04612738

Advance Care Planning Advance Directives Terminal Illness +2 more

RECRUITING NA

A Randomized Controlled Trial of an Advanced Care Planning Video Decision Support Tool for Patients With End-Stage Liver Disease

NCT03557086

End Stage Liver Disease

COMPLETED NA

My Recordable On-Demand Audio Discharge Instructions

NCT02901314

Heart Failure, Congestive

COMPLETED NA

Project to Improve Communication About Serious Illness--Hospital Study: Comparative Effectiveness Trial (Trial 2)

NCT04283994

Dementia Chronic Disease Neoplasm Metastasis +8 more

COMPLETED NA

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Introduction: Fewer than half of all people in the U.S. have a documented advance care plan, such as an advance directive, despite their importance in ensuring high-quality care at the end-of-life. Hospitalization offers an opportunity for physicians to initiate advance care planning (ACP) conversations. Despite expert recommendations, hospital-based physicians (hospitalists) do not routinely engage in these conversations, reserving them for the critically ill.

The objective of this study is to test the effect of a novel behavioral intervention on the incidence of ACP conversations by hospitalists practicing at a stratified random sample of hospitals drawn from 220 US acute care hospitals staffed by a large, nationwide acute care physician practice with an ongoing ACP quality improvement initiative.

Methods and analysis: We developed Hopewell Hospitalist, a theory-based adventure video game, to modify physicians' attitudes towards ACP conversations, and to increase their motivation for engaging in them. Drawing on the theory of narrative engagement, players assume the persona of Andy Jordan, a hospitalist who accepts a new job in a small town. Through a series of clinical encounters with seriously-ill patients over the age of 65, players experience the consequences of having (or not having) ACP conversations in a timely fashion. The planned study is a pragmatic stepped-wedge crossover phase III trial, testing the efficacy of Hopewell Hospitalist for increasing ACP conversations. We will randomize 40 hospitals to the month (step) in which they receive the intervention. We aim to recruit 30 hospitalists from up to 8 hospitals each step to complete the intervention, playing Hopewell Hospitalist for at least 2 hours on an iPad pre-loaded with the game. The primary outcome is ACP billing for patients age 65 and older managed by participating hospitalists. We hypothesize that the intervention will increase ACP billing in the quarter after dissemination, and have 80% power to detect a 1% absolute increase and 99% power to detect a 3.5% absolute increase.

Ethics and dissemination: Dartmouth's Committee for the Protection of Human Subjects has approved the study protocol, which is registered on clinicaltrials.gov. We will disseminate the results through manuscripts and the trials website. Hopewell Hospitalist will be made available on the iOS Application Store for download, free of cost, at the conclusion of the trial.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Advance Care Planning

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

A stepped wedge crossover trial randomizing physician participants at the group level (i.e., hospital). Each hospital group 'crossed over' from control to intervention at a randomized time point.

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors

A hospital's treatment assignment was masked during analysis.

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Usual Care Control

The control arm occurred prior to receipt of the video game intervention. Each hospital group 'crossed over' from control to intervention at a randomized time point based on their assignment to the 'step' of the trial.

Group Type NO_INTERVENTION

No interventions assigned to this group

Video Game Intervention

Each hospital group 'crossed over' from control to intervention at a randomized time point. Physicians working at these hospitals, who agreed to participate in the trial, received a study iPad and were asked to play the video game loaded on the iPad for a minimum of 2 hours.

Group Type EXPERIMENTAL

Hopewell Hospitalist Video Game

Intervention Type BEHAVIORAL

Hopewell Hospitalist is a customized theory-based adventure video game that uses narrative engagement to educate physician players on advance care planning to increase physicians' likelihood of engaging in and billing for ACP conversations.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Hopewell Hospitalist Video Game

Hopewell Hospitalist is a customized theory-based adventure video game that uses narrative engagement to educate physician players on advance care planning to increase physicians' likelihood of engaging in and billing for ACP conversations.

Intervention Type BEHAVIORAL

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Value-based delivery model of care (Bundled Payment Care Initiative)
* Staffed by Sound Physicians for at least 2 quarters
* Advance care planning billing rate in prior quarter greater than 0 percent
* Employs a nurse liaison
* Hospitalist chief approval to approach hospitalists

* Employed by Sound for at least 2 quarters and staffing an eligible hospital for at least 1 quarter
* ACP billing rate in prior quarter greater than 0 percent or answers eligibility question affirming use of ACP billing codes
* Provides informed consent
* Name matches a name in the contact list for the sample; OR is verified by communication through an employer-based email address
* Receipt of a functional iPad within study step time frame

Exclusion Criteria

* Sound Physicians no longer staffing the hospital
* Not staffed by Sound Physicians for at least 2 quarters
* Advance care planning billing rate in prior quarter of 0 percent
* Does not employ a nurse liaison
* Hospitalist chief disapproval to approach hospitalists
* Hospitalist chief does not provide contact information for hospitalists
* Target number of hospitalists for the "step" has been met or exceeded

* Not employed by Sound for at least 2 quarters and staffing an eligible hospital for at least 1 quarter
* ACP billing rate in prior quarter of 0 percent or answers eligibility question refusing use of ACP billing
* Does not provide informed consent
* Provides consent after the given deadline for consenting
* Name does not match a name in the contact list for the sample; OR cannot be verified by communication through an employer-based email address
* Receipt of a nonfunctional iPad within study step time frame
* If the number of participants who consent per site exceeds targets, then participants who are part-time employees will be preferentially excluded

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes