Annette M Totten1, Lyle J Fagnan2, David Dorr3, LeAnn C Michaels2, Shigeko Seiko Izumi4, Angela Combe2, France Légaré5. 1. Department of Medical Informatics and Clinical Epidemiology, Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon. 2. Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon. 3. Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon. 4. School of Nursing, Oregon Health and Science University, Portland, Oregon. 5. Centre de Recherche Sur Les Soins et Les Services de Première Ligne de l'Université Laval, Quebec, Canada.
Abstract
Introduction: For many patients, primary care is an appropriate setting for advance care planning (ACP). ACP focuses on what matters most to patients and ensuring health care supports patient-defined goals. ACP may involve interactions between a clinician and a patient, but for seriously ill patients ACP could be managed by a team. Methods: We are conducting a cluster randomized trial comparing team-based to clinician-focused ACP using the Serious Illness Care Program (SICP) in 42 practices recruited from 7 practice-based research networks (PBRNs). Practices were randomized to one of the two models. Patients are referred to the study after engaging in ACP in primary care. Our target enrollment is 1260 subjects. Patient data are collected at enrollment, six months and one year. Primary outcomes are patient-reported goal-concordant care and days at home. Secondary outcomes include additional patient measures, clinician/team experience, and practice-level measures of SICP implementation. Study Implementation: This trial was designed and is conducted by the Meta-network Learning and Research Center (Meta-LARC), a consortium of PBRNs focused on integrating engagement with patients, families, and other stakeholders into primary care research and practice. The trial pairs a comparative effectiveness study with implementation of a new program and is designed to balance fidelity to the assigned model with flexibility to allow each practice to adapt implementation to their environment and priorities. Our dissemination will report the results of comparing the two models and the implementation experience of the practices to create guidance for the spread of ACP in primary care.
RCT Entities:
Introduction: For many patients, primary care is an appropriate setting for advance care planning (ACP). ACP focuses on what matters most to patients and ensuring health care supports patient-defined goals. ACP may involve interactions between a clinician and a patient, but for seriously ill patients ACP could be managed by a team. Methods: We are conducting a cluster randomized trial comparing team-based to clinician-focused ACP using the Serious Illness Care Program (SICP) in 42 practices recruited from 7 practice-based research networks (PBRNs). Practices were randomized to one of the two models. Patients are referred to the study after engaging in ACP in primary care. Our target enrollment is 1260 subjects. Patient data are collected at enrollment, six months and one year. Primary outcomes are patient-reported goal-concordant care and days at home. Secondary outcomes include additional patient measures, clinician/team experience, and practice-level measures of SICP implementation. Study Implementation: This trial was designed and is conducted by the Meta-network Learning and Research Center (Meta-LARC), a consortium of PBRNs focused on integrating engagement with patients, families, and other stakeholders into primary care research and practice. The trial pairs a comparative effectiveness study with implementation of a new program and is designed to balance fidelity to the assigned model with flexibility to allow each practice to adapt implementation to their environment and priorities. Our dissemination will report the results of comparing the two models and the implementation experience of the practices to create guidance for the spread of ACP in primary care.
Entities:
Keywords:
Practice-Based Research Networks; advance care planning; cluster randomized trial; primary care; serious illness care; team care
Authors: David L Hahn; Amanda E Hoffmann; Maret Felzien; Joseph W LeMaster; Jinping Xu; Lyle J Fagnan Journal: Fam Pract Date: 2017-06-01 Impact factor: 2.267
Authors: Tammy C Hoffmann; Paul P Glasziou; Isabelle Boutron; Ruairidh Milne; Rafael Perera; David Moher; Douglas G Altman; Virginia Barbour; Helen Macdonald; Marie Johnston; Sarah E Lamb; Mary Dixon-Woods; Peter McCulloch; Jeremy C Wyatt; An-Wen Chan; Susan Michie Journal: BMJ Date: 2014-03-07
Authors: Anne M Walling; Rebecca L Sudore; Doug Bell; Chi-Hong Tseng; Christine Ritchie; Ron D Hays; Lisa Gibbs; Maryam Rahimi; Javier Sanz; Neil S Wenger Journal: J Palliat Med Date: 2019-09 Impact factor: 2.947