Advance Care Planning Evaluation in Hospitalized Elderly Patients (ACCEPT)
The purpose of the study is to inform decision-makers of the best strategies to implement advanced care planning (ACP).
An advanced care plan (ACP) is a verbal or written instruction describing what kind of care an individual would want (or not want)if they are no longer able speak for themselves to make health care decisions.
Chronic Obstructive Lung Disease
Congestive Heart Failure
|Study Design:||Time Perspective: Prospective|
|Official Title:||Advance Care Planning Evaluation in Hospitalized Elderly Patients: A Multicenter, Prospective Study|
- Extent of Implementation of ACP [ Time Frame: Year 3 ] [ Designated as safety issue: No ]
- Effect of an audit and feedback process plus tailored interventions ACP [ Time Frame: Year 3 ] [ Designated as safety issue: No ]Compared to baseline, what is the effect of an audit and feedback process coupled with tailored interventions on use of and satisfaction with ACP at the site level?
- Impact of ACP on patient/family satisfaction [ Time Frame: Year 3 ] [ Designated as safety issue: No ]Compared to those patients who have not undergone an ACP process upon enrolment, what is the impact of ACP on patient/family satisfaction with care, use of life-sustaining technologies, and hospital resources during index hospital admission and long-term health care utilization?
- ACP components associated with overall satisfaction [ Time Frame: Year 3 ] [ Designated as safety issue: No ]Which components of ACP are more strongly associated with overall satisfaction with EOL communication and decision making?
- Comparison of sites with low vs high system level implementation of ACP on satisfaction [ Time Frame: Year 3 ] [ Designated as safety issue: No ]At baseline, compared to sites with low degrees of system level implementation, do sites with higher levels of system level integration have a higher prevalence of ACP and greater satisfaction with EOL communication and decision-making?
|Study Start Date:||September 2011|
|Estimated Study Completion Date:||July 2014|
|Estimated Primary Completion Date:||December 2013 (Final data collection date for primary outcome measure)|
Advance Care Planning (ACP) may offer some assistance with reducing health care costs for older Canadians and yet, at the same time, improving quality of care. ACP is the process by which a person considers options about future health care decisions and identifies their wishes. ACP has been shown to increase the quality of life of dying patients, improve the experience of family members, and decrease health care costs.
There have been initiatives leading to the development and implementation of system-wide strategies to increase ACP, however there has been no evaluation of the effectiveness of these efforts from the perspective of patients and families. Many questions pertaining to barriers and facilitators to implementation and impact of ACP on outcomes in Canada remain.
The investigators propose to conduct a perspective audit of current practice related to ACP in elderly patients at high-risk for dying and their families. The investigators will determine the extent to which these patients and families have engaged in ACP, what barriers and facilitators they preceive, and how satisfied they are with communication and decision making at the end of life. Informed by a baseline evaluation of site strengths, weaknesses and barriers, the investigators propose to develop tailored interventions to enable participating sites to improve their success with ACP during the entire study period. By repeating the audit and feedback cycle annually, the investigators will enable sites to make continuous efforts to improve their performance and be able to evaluate the effect of our audit/feedback/tailored intervention strategy compared to baseline. Additionally, for those patients who have engaged in ACP activities, the investigators can compare their outcomes to those who have not.
The overall goal of this study is to inform decision-makers as the best strategies to implement advance care planning (ACP).
|Kingston General Hospital||Recruiting|
|Kingston, Ontario, Canada, K7L 2V7|
|Contact: Daren K Heyland, MD, MSc 613-549-6666 ext 4847 email@example.com|
|Contact: Deborah Pichora, RN, MScN 613-549-6666 ext 6266 firstname.lastname@example.org|
|Principal Investigator: Daren K Heyland, MD, MSc|
|Principal Investigator:||Daren K Heyland, MD, MSc||Queen's University|