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Evaluation of an Intervention Designed to Enhance the Quality of Decision Support Provided to Patients Making Decisions About End-of-life Place of Care

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ClinicalTrials.gov Identifier: NCT00614003
Recruitment Status : Completed
First Posted : February 13, 2008
Last Update Posted : May 25, 2015
Information provided by (Responsible Party):
Ottawa Hospital Research Institute

Brief Summary:

Most dying cancer patients would prefer a home death yet die in an institution. Patients can experience uncertainty when weighing practical considerations, concern for others, and their personal ratings about the desirability and undesirability of various outcomes related to different locations of care. Health professionals, trained in decision support, can help patients to make decisions that are informed by both relevant information and what outcomes are most valued by patients. Therefore, I will study if an educational intervention can help nurses and case managers to strengthen their skills and confidence in providing patient decision support around place of end of life care.

Project Description:

Using a two step approach I will study if the quality of providers decision support can be improved with an education. In step one nurses and care coordinators will be interviewed to identify factors that make it easier or more difficult to provide patient decision support. This information will be used to develop an education program. In step two, nurses and care coordinator volunteers will be assigned by a flip of a coin to either receive the decision support education or not. Before and after the education program the quality of the decision support participants provide will be measured and compared. As well, participants receiving the education program will be asked about their satisfaction with the education program.

Condition or disease Intervention/treatment Phase
Palliative Care Behavioral: Decision support skills building Intervention Phase 2

Detailed Description:

Most terminal cancer patients prefer home palliation yet die in an institution. Some experience decisional conflict when weighing options regarding place of care. Community Case Managers and Nurses are well positioned to identify decisional needs and provide decision support; however, they generally lack skills and confidence in doing so. This study aims to determine whether the quality of case managers' and nurses' decision support can be improved with a theory-based skills-building intervention.

In phase one a needs assessment will be conducted with about 20 key informants. In phase two, nurses will be randomly allocated to an intervention or control group. The intervention, informed by the needs assessment, is comprised of: an auto-tutorial; an interactive skills building workshop; a decision support protocol; performance feedback, and educational outreach.

Participants will be assessed: a) at baseline (quality of decision support); b) after the auto-tutorial (knowledge); and six to eight weeks after the other interventions (quality of decision support; confidence and intention to integrate decision support into practice). Between group differences in the primary outcome (quality of decision support scores) will be analyzed using a repeated measures ANOVA.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 90 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Official Title: Efficacy of a Training Intervention on the Quality of Case Coordinators and Nurses' Decision Support for Patients Deciding About the Place of Care at the End Of-Life: A Randomized Control Trial
Study Start Date : April 2007
Primary Completion Date : June 2008
Study Completion Date : June 2008

Arm Intervention/treatment
Experimental: 1
decision support
Behavioral: Decision support skills building Intervention
Decision support skills

Primary Outcome Measures :
  1. Decision support quality audit using simulated patients measured by the validated and reliable Decision Support Analysis Tool [ Time Frame: 6 month ]

Secondary Outcome Measures :
  1. Knowledge of place of care determinants and decision support concepts; self perceived quality of decision support provision in clinical practice and behavior intention survey; acceptability and utility of intervention components [ Time Frame: 6 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

Nurses and case coordinators who:

  • are members of a regulated health profession
  • care for palliative cancer patients, and/or
  • cancer patients with advanced disease, and
  • work at least 4 shifts per month,
  • in a clinical area where end of life care discussions are likely to be undertaken, and
  • are proficient in written and spoken English.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00614003

Canada, Ontario
St. Elizabeths Health Care Agency
Kingston, Ontario, Canada
Ottawa Carefor Nursing Services
Ottawa, Ontario, Canada
SCOHS Regional Palliative Care Community Services
Ottawa, Ontario, Canada
The Ottawa Hospital
Ottawa, Ontario, Canada
Community Care Access Center's (CCAC)
Toronto, Ontario, Canada
Sponsors and Collaborators
Ottawa Hospital Research Institute
Principal Investigator: Annette O'Connor, MD Ottawa Hospital Research Institute

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Ottawa Hospital Research Institute
ClinicalTrials.gov Identifier: NCT00614003     History of Changes
Other Study ID Numbers: H-01-07-09
First Posted: February 13, 2008    Key Record Dates
Last Update Posted: May 25, 2015
Last Verified: May 2015

Keywords provided by Ottawa Hospital Research Institute:
decisional conflict;
decision quality;
place of end of life care;
provider education