Behavioral Economics for Advance Care Options (BEACON)
People with life-limiting illness often receive more aggressive healthcare than desired including costly procedures that provide little medical benefit. Advance Directives (AD) can reduce this effect but various factors limit their adoption.
A randomized trial will target hospitalized patients with a serious, life limiting illness to test if the behavioral economics principles of endowment (possessing something) and focusing (featuring something important to patients) can motivate AD completion. Investigators will examine if offering patients an AD by default, in combination with framing the rationale for AD completion (emphasizing patient control or caregiver burden) improves AD completion and family conversation compared to a no-intervention group. The study hypothesis is to determine if rates of AD completion and family conversations will be highest among patients receiving the intervention focused on reduced caregiver burden; and if the two intervention groups will have higher rates of both than the control group.
The investigators suspect that a small change in how patient information is framed (endowment and focusing used in tandem) will potentially leverage large increases in AD completion and that targeting HHC patients allows AD discussions early in the disease trajectory when they can participate in care decisions.
|End of Life Care||Behavioral: Counseling (Care giver burden focus) Behavioral: Counseling (patient autonomy focus)|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
|Official Title:||Behavioral Economics for Advance Care OptioNs|
- Advance directive document completion [ Time Frame: 1 month ]The number of advance directive documents completed within one month of enrollment.
- Advance Directive document completion [ Time Frame: 1 year ]The number of advance directive documents completed within one year of enrollment.
- Advance directive communication [ Time Frame: 1 year ]The number of patients who discuss advance directives with their family or care giver within one year of enrollment.
|Study Start Date:||April 2014|
|Estimated Study Completion Date:||October 2017|
|Primary Completion Date:||October 2016 (Final data collection date for primary outcome measure)|
Experimental: Behavioral Counseling
Provide an advance directive document to patients along with counseling that either focuses on care giver burden or on patient autonomy.
Behavioral: Counseling (Care giver burden focus)
An advance directive (AD) document is provided to the patient along with counseling that focuses on care giver burden as the reason for adoption of the AD.
Other Name: Focusing effectBehavioral: Counseling (patient autonomy focus)
An advance directive (AD) document is provided to the patient along with counseling that focuses on patient autonomy (control) as the reason for adoption of the AD.
Other Name: Focusing effect
No Intervention: Standard AD
The topic of advance directives (AD) is introduced but patient receives an AD document only upon request.
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT02100566
|United States, Michigan|
|Genesys Regional Medical Center|
|Grand Blanc, Michigan, United States, 48439|
|Principal Investigator:||Mark E Vogel, PhD||Genesys Regional Medical Center|
|Principal Investigator:||Scott Halpern, MD, PhD||University of Pennsylvania|
|Study Director:||Kimberly R Barber, PhD||Genesys Regional Medical Director|