Goals of Care Conversations Training for Seriously Ill Patients
(LSTDI Trial)

Recruiting in Palo Alto (17 mi)

+2 other locations

Overseen byAnne M Walling, MD PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: VA Office of Research and Development

No Placebo Group

Trial Summary

What is the purpose of this trial?

The long term goal is to improve quality of care in Veterans with serious illnesses by aligning medical care with Veterans' goals and values. The objective of this study is to use a sequentially randomized trial to determine what implementation strategies are effective to increase early, outpatient goals of care conversations. The study will use interviews with and surveys of medical providers, patients, and caregivers, along with medical record data. This work is significant because it tests ways Veterans can express their goals and preferences for life sustaining treatments and have them honored.

Research Team

David Bekelman, MD MPH

Principal Investigator

Rocky Mountain Regional VA Medical Center, Aurora, CO

Anne M Walling, MD PhD

Principal Investigator

VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Eligibility Criteria

This trial is for Veterans with serious illnesses like cancer, heart failure, lung diseases, kidney or liver failure, and dementia. They must be enrolled in VHA healthcare at one of the study sites and have a high risk of hospitalization or death within a year. Clinicians eligible are those who need to improve their skills in discussing care goals with patients.

Inclusion Criteria

CLINICIANS VA primary care advance practice clinicians (MDs, APRNs, PAs) at one of the three study sites able to complete goals of care conversation notes and orders. Advance practice clinicians will be eligible for randomization if they have at least 15 eligible patients without goals of care conversation notes at the start of stage 1 (to allow participating clinicians ample opportunities to write notes) and have written fewer than 4 goals of care conversation notes in the previous 6 months (to select clinicians who need improvement), and can potentially receive the planned implementation strategies, i.e., clinicians who regularly attend the Patient Aligned Care Team (PACT) team meetings.

I have been diagnosed with a serious condition like cancer, heart failure, or dementia.

It seems like the criterion you provided is incomplete. Can you please provide more details or context for me to help you better?

See 3 more

Exclusion Criteria

Prisoner

Pregnant

I am younger than 18 years old.

Treatment Details

Interventions

Clinician Implementation Strategy Stage 1 (Behavioral Intervention)
Clinician Implementation Strategy Stage 2 (Behavioral Intervention)
High patient engagement (Behavioral Intervention)
Low patient engagement (Behavioral Intervention)

Trial OverviewThe study tests different strategies to help clinicians engage in early conversations about care goals with seriously ill patients. It involves two stages: low intensity training followed by high intensity training for clinicians, paired with varying levels of patient engagement.

Participant Groups

4Treatment groups

Active Control

Group I: Low then high patient engagementActive Control4 Interventions

First stage: Low intensity patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): High patient engagement and high intensity clinician training.

Group II: No then low patient engagementActive Control3 Interventions

First stage: No patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): Low intensity patient engagement and high intensity clinician training.

Group III: Low then low patient engagementActive Control3 Interventions

First stage: Low patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): Low intensity patient engagement and high intensity clinician training.

Group IV: No then high patient engagementActive Control3 Interventions

First stage: No patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): High patient engagement and high intensity clinician training.