Advanced Care Planning for the Severely Ill Home-dwelling Elderly

Launched by UNIVERSITY OF OSLO · Jan 3, 2023

Keywords

ClinConnect Summary

This clinical trial is focused on improving advance care planning for elderly patients who are seriously ill and living at home. Advance care planning is a process that helps patients express their wishes about medical treatment in case they become unable to communicate those wishes in the future. The study involves twelve hospital units in Norway, where half will receive immediate support and training to help implement this planning, while the other half will begin receiving support later. Researchers will assess how well this planning is put into practice and gather feedback from both healthcare staff and patients, as well as their relatives, to understand the challenges and benefits of these discussions.

To be eligible for this trial, patients must be 70 years or older, live at home, and have been acutely admitted to the hospital. They also need to be willing to participate in advance care planning discussions with a close relative. It’s important that both the patient and their relative can understand Norwegian and agree to take part in the study. Participants can expect to be involved in important conversations about their future healthcare preferences, and their experiences will help shape how advance care planning is done in the future.

Gender

ALL

Eligibility criteria

• Inclusion and exclusion criteria for patients and relatives the quantitative and triadic sub-study:
• Inclusion criteria for patients:
• • Home-dwelling
• • 70 years or older
• • Acutely admitted to the participating unit
• • Sufficient language proficiency in Norwegian to answer the questionnaire
• • Clinical frailty score of 4 or more
• • The physician responsible for the patient's medical care answers "no" to "Surprise question" from Gold Standards Framework proactive identification guidance
• • Both patient and a close relative (preferably the closest relative) would participate in ACP together if offered
• • Both patient and the close relative consent to participate in the research project
• Exclusion criteria for patients:
• • The patient is not competent to consent to research participation
• • The patient is expected to die within 24 hours
• • The patient has participated in ACP prior to the current hospital admission
• • In the intervention arm
• • ACP is not conducted with patient, next of kin and physician before hospital discharge
• • The clinician that participated in the ACP conversation has not consented to research participation
• • In the control arm
• • The patient would not have been able to participate in ACP during hospitalization
• • An attending clinician has not consented to research participation
• Inclusion criteria for relatives:
• • A close relative of a patient who fulfill all inclusion criteria and no exclusion criteria; and who would be willing to participate in ACP together with the patient if offered
• • 18 years or older
• • Sufficient language proficiency in Norwegian to answer the questionnaire
• • Both patient and the close relative consent to participate in the research project
• Exclusion criteria for relatives:
• • The relative is not competent to consent to research participation
• • In the intervention arm
• • ACP is not carried out with the patient, next of kin and attending clinician before hospital discharge
• • In the control arm
• • The relative would not have been able to participate in ACP during hospitalization