Enabling Advance Directive Completion (EADCRAV)

• The primary study outcome measure is Advance Directive completion rate. [ Time Frame: Up to 1 month after intervention ] [ Designated as safety issue: No ]
  We adhere to the Intent-to-Treat principle, classifying subjects based on randomized group assignment. We will present Advance Directive completion (presence of the scanned Advance Directive in CPRS/Vista Imaging) rates for both the Nurse-Supported ACP Intervention and Care-as-Usual groups.
  
  

Background:

The VHA mission to serve the health care needs of America's veterans assumes a veteran-centered approach - one that evolves not only from the health team's assessment of needs, but especially one that begins with the veteran's assessment of his or her own needs. Preliminary data from the Alabama Veterans Rural Health Initiative study suggest that approximately 30% of rural Alabama veterans do not have an Advance Directive and want help completing one. Rural Alabama veterans live in counties with a higher percent of African American minorities, lower levels of education, and higher family poverty rates, than the average for the US population at large. Prior studies have demonstrated that disparities in Advance Directive completion rates may be related to race, level of income, and level of education. VHA research priorities include addressing the challenges of minority health care needs and the disparities that arise in healthcare delivery. Although many studies evidence the effectiveness of education and counseling in facilitating Advance Directive completion, data are lacking that demonstrate the efficacy of resource-conservative nursing interventions to enable Advance Directive completion by rural, southern minorities. This pilot lays the groundwork to address this evidence gap.

Objectives:

The objectives of the pilot study are to (1) test the feasibility of recruitment, randomization, and retention; (2) test the feasibility of a standardized Nurse-Supported Advance Care Planning Intervention; (3) evaluate the feasibility of the assessment process and data collection procedures; (4) evaluate the Veterans' satisfaction with the intervention and their Advance Directive decisions; and (5) evaluate preliminary effects of the Nurse-Supported Advance Care Planning Intervention.

Methods:

A prospective, randomized, controlled pilot study. Fifty Alabama veterans who receive care at the Tuscaloosa VA Medical Center will be prospectively randomized to either the Nurse-Supported Advance Care Planning Intervention or Care-as-Usual. The Nurse-Supported Advance Care Planning Intervention is a manualized education, support, and guidance session provided by a Registered Nurse that includes information about risks, benefits, and alternatives of specific choices. The Care-as-Usual is a session with the social worker who explains what the Advance Directive is, and guides the Veteran regarding the process of completing the Advance Directive document, without providing information about risks, benefits, and alternatives of specific choices. Data related to recruitment, randomization, and retention; study completion by subjects; completeness of data collection; Veterans' satisfaction; and preliminary effects of the intervention will be collected, analyzed, and evaluated.

Status:

The Tuscaloosa VA Medical Center IRB has approved this study. This study is not yet open to enrollment