Improving PCP Advance Care Planning for People With ADRD
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18-99
SponsorUniversity of Pittsburgh
About this trial
This study will test the Dementia Advance Care Planning (AD ACP) Toolkit intervention to usual care in facilitating goals of care (GOC) discussions between People Living with Dementia (PLwD) and primary care team members over an 18-month period. The primary outcome is to assess the frequency and quality of GOC discussions with PLwD. Secondary outcomes include the identification of preferred surrogates, assessment of decisional capacity, and the completion of portable ACP orders. This randomized clinical trial aims to determine if the AD ACP Toolkit can enhance ACP practices and improve care planning outcomes for PLwD compared to the standard care approach.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Must be an MD/APP, employed at a primary care clinic within UNC HEALTH clinics with ≥60 PLwD encounters per year, who sees older adult patients, along with their associated nurses and social workers.
Eligibility for training with AD ACP Toolkit will include the above and the provision of care at an intervention clinic.
For Aim 3, only the trained intervention site primary care team members will be eligible for the implementation surveys or the interviews.
Must be a PLwD age 65 years or older seen by either the intervention or control sites' primary care teams' MD/APP in the 18-month intervention window for Aim 1.
Disqualifiers
We will exclude primary care team members who do not care for older adults (e.g. pediatricians or lactation nurses), are employed at geriatric specialty or dementia specialty clinics, or are without a primary care panel (e.g., only urgent care).
Patients will be excluded if they have not been seen in the past 18 months by their primary care team, or if they do not have a diagnosis of ADRD.
Trial design
Design model
Parallel
Treatments tested in this trial
Primary Care Team Advance Care Planning With People with Alzheimer's Disease or a Related Dementia Training
BehavioralIncluded in arm/group descriptions
Care as Usual
BehavioralIncluded in arm/group descriptions
Treatment groups
120 Participants
are divided into 2 treatment groupsGroup A: Intervention: Advance Care Planning TrainingExperimental treatment 1 intervention
Group B: Care as Usual: No TrainingActive comparator 1 intervention
Trial outcomes
Primary outcomes
1
Goals of Care Discussions
Presence of a documented Goals of Care (GOC) discussion between the primary care team member and the Person Living with Dementia (PLwD) or their surrogate decision-maker. Medical record documentation of discussion must include a) communication about dementia stage or prognosis AND b) decision-making for at least one major treatment: CPR/mechanical ventilation, hospitalization, treatments for infections, artificial/feeding/hydration, OR hospice.
Time frame
18 monthsSecondary outcomes
1
Surrogate Decision-Maker
Choice of a surrogate decision-maker for the PLwD documented in the medical record.
Time frame
18 months2
Decision-Making Capacity
Assessment and report of decision-making capacity for the PLwD documented in the medical record.
Time frame
18 months3
Portable Advance Care Planning (ACP) Orders
Completion of portable ACP orders using a state-approved DNR or POLST form documented in the medical record.
Time frame
18 months4
Prognosis Discussion
Discussion of prognosis or future medical complications of Alzheimer's Disease/Alzheimer's Disease and Related Dementias (AD/ADRD) between the primary care team member and the PLwD or their surrogate decision-maker documented in the medical record.
Time frame
18 monthsSponsors and contacts
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University of Pittsburgh
Lead sponsor
University of North Carolina, Chapel Hill
Collaborator
National Institute on Aging (NIA)
Collaborator
Source ClinicalTrials.gov