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Intervention to Improve Care at Life's End (BEACON)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT00234286
First received: October 4, 2005
Last updated: September 15, 2014
Last verified: September 2014

October 4, 2005
September 15, 2014
August 2005
March 2011   (final data collection date for primary outcome measure)
Presence of order for opioid pain medication [ Time Frame: at time of death ] [ Designated as safety issue: No ]
Presence of order for opioid pain medication at time of death based on abstraction of electronic medical record
  • 4. Presence of nasogastric tube or intravenous line at time of death
  • 1. Presence of order for opioid pain medication at time of death
  • 2. Do Not Resuscitate order present
  • 3. Location of death (ICU vs. other)
  • 5. Presence of restraints at or near time of death
  • During 12 mo. period before & after intervention.
Complete list of historical versions of study NCT00234286 on ClinicalTrials.gov Archive Site
  • Do Not Resuscitate order [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Presence of a Do Not Resuscitate order at time of death based on abstraction of electronic medical record
  • Location of death [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Location of death (ICU vs. other) based on abstraction of electronic medical record
  • Presence of nasogastric tube [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Presence of nasogastric tube based on abstraction of electronic medical record
  • Presence of intravenous line [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Presence of intravenous line infusing at time of death based on abstraction of electronic medical record
  • Presence of restraints [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Presence of restraints at or near time of death at time of death based on abstraction of electronic medical record
  • Administration of opioid medication [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Administration of opioid medication based on abstraction of medical record
  • Order for antipsychotic medication [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Order for antipsychotic medication based on abstraction of medical record
  • Administration of antipsychotic medication [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Administration of antipsychotic medication based on abstraction of medical record
  • Order for benzodiazepine medication [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Order for benzodiazepine medication based on abstraction of medical record
  • Administration of benzodiazepine medication [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Administration of benzodiazepine medication based on abstraction of medical record
  • Administration of scopolamine [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Administration of scopolamine (for death rattle) based on abstraction of medical record
  • Sublingual administration [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Sublingual administration of medication based on abstraction of medical record
  • Palliative care consultation [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Palliative care consultation based on abstraction of medical record
  • Presence of advance directive [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Presence of advance directive based on abstraction of medical record
  • Pastoral care visit [ Time Frame: before and after intervention ] [ Designated as safety issue: No ]
    Pastoral care visit based on abstraction of medical record
  • Symptoms/care plans, advance directives, resuscitations, hospice care, palliative consults, presence of family at time of death, pastoral services, info on hospital stay, locations of care, utilization info
  • After-death interviews of family on attitudes, perceptions & satisfaction w/care
Not Provided
Not Provided
 
Intervention to Improve Care at Life's End
Intervention to Improve Care at Life's End in VA Medical Centers

The BEACON trial (Best Practices for End-of-Life Care for Our Nations' Veterans) was a six-site implementation study to evaluate a multi-component, education-based intervention to improve the quality of end-of-life care provided in VA Medical Centers.

The BEACON trial (Best Practices for End-of-Life Care for Our Nations' Veterans) was a six-site, real-world implementation trial of a multi-component, education-based intervention to improve the quality of end-of-life care conducted in VA Medical Centers (VAMCs).

The primary aim was to evaluate the effectiveness of a multi-component intervention for improving processes of care provided in the last days of life in VAMCs. The second aim was to conduct after-death interviews with next-of-kin and qualitative analysis of their perceptions of the care provided to the veteran and family.

The multi-component intervention targeted VAMC inpatient providers, including physician, nursing, and ancillary staff. It consisted of preparatory site visits, a staff training program, a newly developed Comfort Care order set decision support tool built into the CPRS, and follow-up consultation. The intervention team travelled to each site to conduct two weeks of comprehensive in-service training. Staff were trained to identify actively-dying patients and implement a set of best practices of traditionally home-based hospice care for dying patients. The team provided assistance with policies, procedures, and skill training needed to implement comfort care interventions. Introduction of the intervention at each VAMC was staggered across time at six-month intervals using a multiple-baseline, stepped wedge design.

Data on processes of end-of-life care (last 7 days) were abstracted from the CPRS medical records of all veterans who died before, during, and after the intervention (January 2005-February 2011). A priori, five processes of care were identified as primary endpoints to indicate quality of end-of-life care: 1) presence of an order for opioid pain medication at time of death; 2) a do-not-resuscitate (DNR) order in place at time of death; 3) location of death; 4) presence of enteral feeding tube or intravenous line at time of death; and 5) physical restraints in place at or near time of death.

In addition, in-depth, face-to-face interviews were conducted with 78 bereaved next-of-kin.

Interventional
Not Provided
Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Health Services Research
  • Death
  • Pain
  • Dyspnea
Behavioral: Comfort care education intervention
Comfort care education intervention, consisting of intensive, on-site staff training together with an electronic order set for palliative care and educational materials
Experimental: Arm 1
Comfort care education intervention, consisting of intensive, on-site staff training together with an electronic order set for palliative care and educational materials
Intervention: Behavioral: Comfort care education intervention

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
78
September 2013
March 2011   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Aim 1: Not applicable. Patients were deceased.
  • Aim 2: After-death interviews with next of kin: must be willing and able to participate in after-death interview at local VA Medical Center.

Exclusion Criteria:

  • N/A
Both
Not Provided
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00234286
IIR 03-126
No
Department of Veterans Affairs
Department of Veterans Affairs
Not Provided
Principal Investigator: Kathryn L Burgio, PhD MA BA Department of Veterans Affairs
Department of Veterans Affairs
September 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP