End-of-life care involves high costs, but frequently fails in providing optimal patient centred care and quality of life. In the US, Advance Care Planning (ACP), a formalised process of communication about care preferences, has resulted in better…
ID
Source
Brief title
Condition
- Other condition
Synonym
Health condition
Wilsbekwame ouderen.
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Primary: Patient Activation (PAM), quality of life (SF-12), costs and
cost-effectiveness of ACP.
Secondary outcome
Secondary: Satisfaction with care, use of medical care during 12 months,
assignment of proxy decision-maker and advance directive.
Background summary
Currently, health care and medical decision-making for older people are often
insufficiently patient-centred. Communication about people*s needs and
preferences is typically postponed until acute events necessitate short-term
medical decision-making. At that stage, patients are often unprepared or unable
to make decisions while relatives and professional caregivers are unaware of
their wishes and preferences, which may result in overtreatment and a
suboptimal quality of the last phase of life.
Study objective
End-of-life care involves high costs, but frequently fails in providing optimal
patient centred care and quality of life. In the US, Advance Care Planning
(ACP), a formalised process of communication about care preferences, has
resulted in better patient outcomes and significant cost savings. In the
Netherlands, interest in ACP is increasing, but data on cost-effectiveness are
lacking. We aim to assess cost-effectiveness of ACP in elderly people.
Study design
The study design will be a cluster RCT, with randomisation based on the postal
code of the area (4 numbers). Both people living in residents and people living
at home receiving home care will participate in this study. An advantage of
this design is that participants in the control group do not have contact with
individuals in the intervention group and vice versa. Before randomisation
takes place, all participating neighbourhoods will be classified in more rich
and more poor neighbourhoods based on average income from 2006. Within this
subgroups randomisation will take place.
Intervention
The Respecting Choices Model involves a coordinated approach to ACP. Trained
facilitators empower individuals to reflect on their care preferences, to
discuss these with relatives and professionals, to appoint a surrogate
decision-maker, and to document care wishes.
Study burden and risks
A disadvantage is that participants have to talk about topics where they might
not feel comfortable with. Furthermore there are no burdens and risks.
Laan van Nieuw Oost-Indie 334
Den Haag 2593 CE
NL
Laan van Nieuw Oost-Indie 334
Den Haag 2593 CE
NL
Listed location countries
Age
Inclusion criteria
- > 75 years of age;
- Mentally competent, as measured by a Mini-Mental State Examination (MMSE score > 16) and subsequently by judgement of caregiver;
- Fluent in Dutch;
- Living in a care home or at home receiving home care;
- Being frail, as measured by the Tilburg Frailty Index (TFI score of 5 or more)
Exclusion criteria
Not fulfilling the inclusion criteria
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL46444.078.13 |