Treatment for Advance Directives

Phase-Based Progress Estimates
1
Effectiveness
1
Safety
University of California at Los Angeles, Los Angeles, CA
Advance Directives+2 More
Eligibility
18+
All Sexes
Eligible conditions
Select

Study Summary

This study is evaluating whether a combination of interventions will increase the number of patients who complete advance directives and the number of patients who receive care that is consistent with their wishes. original:

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Eligible Conditions

  • Advance Directives
  • Cancer, Advanced
  • Advance Care Planning

Treatment Effectiveness

Effectiveness Estimate

1 of 3

Study Objectives

This trial is evaluating whether Treatment will improve 2 primary outcomes, 7 secondary outcomes, and 3 other outcomes in patients with Advance Directives. Measurement will happen over the course of 12 months or death.

12 months
Research cohort: advance care planning process, 12 months
12 months or death
Advance directive completion, 12 months
New advance directive completion, 12 months
Research cohort: Goal concordant care, cross-sectional survey, 12 months
24 months
Healthcare utilization among decedents
Research cohort: Report of end of life care
Research cohort: advance care planning process, 24 months
24 months or death
Advance directive completion, 24 months
New advance directive completion, 24 months
Research cohort: Goal concordant care, comparison of care to preferences
Research cohort: Goal concordant care, cross-sectional survey, 24 months
Research cohort: Goal concordant care, post-mortem survey

Trial Safety

Trial Design

3 Treatment Groups

Advance directive, Prepare and Facilitator
1 of 3
Advance directive
1 of 3
Advance directive and Prepare
1 of 3
Active Control

This trial requires 6400 total participants across 3 different treatment groups

This trial involves 3 different treatments. Treatment is the primary treatment being studied. Participants will all receive the same treatment. There is no placebo group. The treatments being tested are not being studied for commercial purposes.

Advance directive, Prepare and FacilitatorMessaging and advance directive distribution, introduction to the Prepare For Your Care website, plus patient engagement from a trained facilitator who also can interact with the primary care physician. All arms receive physician advance care planning education at the clinic level.
Advance directive
Behavioral
Messaging and advance directive distribution. All arms receive physician advance care planning education at the clinic level.
Advance directive and PrepareMessaging and advance directive distribution plus introduction to the Prepare For Your Care website. All arms receive physician advance care planning education at the clinic level.

Trial Logistics

Trial Timeline

Approximate Timeline
Screening: ~3 weeks
Treatment: Varies
Reporting: 24 months
This trial has the following approximate timeline: 3 weeks for initial screening, variable treatment timelines, and roughly 24 months for reporting.

Who is running the study

Principal Investigator
N. W.
Prof. Neil Wenger,, MD
University of California, Los Angeles

Closest Location

University of California at Los Angeles - Los Angeles, CA

Eligibility Criteria

This trial is for patients born any sex aged 18 and older. There are 3 eligibility criteria to participate in this trial as listed below.

Mark “yes” if the following statements are true for you:
for all patients At least two visits to a primary care clinic in the past twelve months for all patients. show original
A study published in JAMA Internal Medicine used electronic health records to identify patients with serious illnesses show original
Population cohort

Patient Q&A Section

Can advance directives be cured?

"Providing advance directives for patients who have never received explicit instructions regarding treatment decisions (such as how a patient, family member, or professional should allocate resources) is not likely to yield significant medical benefits." - Anonymous Online Contributor

Unverified Answer

How many people get advance directives a year in the United States?

"Nearly 6% of Medicare beneficiaries signed written directives by the end of 2011, and approximately 26% have spoken to a doctor about this. Almost all of those with directives used them, and more than 50% used them before they got sick. Results from a recent clinical trial underscore the importance of the physician's discussion of advance directives with patients." - Anonymous Online Contributor

Unverified Answer

What causes advance directives?

"Advance directives are often used by an individual who has a serious illness, and their use may be associated with an improved quality and quality-adjusted life expectancy and lower costs for health care." - Anonymous Online Contributor

Unverified Answer

What is advance directives?

"Advance directives are a common topic when asked about in the context of patient care. They convey a variety of meanings. For health professionals, they are a source of confidence and guidance on what is desired and desired not." - Anonymous Online Contributor

Unverified Answer

What are the signs of advance directives?

"With these signs and symptoms the patient may be able to make an advance directive. But the best way is for the patient to discuss the situation and plan ahead with their caregiver. The best time for this is at the physician visits. The physician can make this an optional plan for the patient." - Anonymous Online Contributor

Unverified Answer

What are common treatments for advance directives?

"Many of the patients discussed advance directions and had discussion of treatment decisions, but most did not have a living will. Advance directives are most often written with a physician or hospice caring for the care- giver; a spouse/partner, as living wills are more frequently written with a spouse/partner, or without caregiver. If the advance directive is written with an health care proxy and the patient is incapacitated, one-third of the patients will have some kind of treatment discussed. Many of those discussing advance treatment decisions would prefer to be the decision makers rather than their spouses/partners. For those patients who received treatment, physicians, and/or hospice providers often discuss treatment options and outcomes of the advanced directive." - Anonymous Online Contributor

Unverified Answer

Has treatment proven to be more effective than a placebo?

"There is a lack of consensus among researchers or clinicians regarding the level of clinical evidence on which to base evidence-based practice regarding the use of placebos in clinical trials. Some clinical trials may fail to detect the difference that they were designed to determine, either because no true differences existed in either treatment group or because there was no difference between the treatment groups as assessed in the study. This could lead to erroneous conclusions. Results from a recent paper of clinical trials should be interpreted with caution, but there is no convincing empirical evidence that suggests that a placebo is more effective than an treatment. More research on the effects of placebos is needed." - Anonymous Online Contributor

Unverified Answer

How does treatment work?

"Patients want to know that treatment will prevent future symptoms (both physical and psychosocial). Patients want to take the time and receive the information they need to make the decisions they want. Treating patients in an open-minded manner and respecting patient-centered autonomy is the only way to achieve their best outcomes." - Anonymous Online Contributor

Unverified Answer

Does treatment improve quality of life for those with advance directives?

"The questionnaire administered to this group of patients found that patients' quality of life was not significantly different between those with and without advance directives. The findings suggest that most patients do not view having an advance directive as a negative way of dealing with end-of-life issues and/or dying." - Anonymous Online Contributor

Unverified Answer

What are the common side effects of treatment?

"The side effects associated with HDAC inhibitors appear mainly dose dependent and are mostly mild in nature, with the exception of myelodysplasia, and are therefore manageable by interrupting therapy." - Anonymous Online Contributor

Unverified Answer

What are the latest developments in treatment for therapeutic use?

"The data in the table illustrate the use and utilization of therapeutic use advance directive. The latest therapeutic use advance directive trends demonstrate that use of the advance directive is a growing trend and it is an important tool for patients and families contemplating therapeutic and supportive care. More research needs to be conducted to further validate, test and develop the therapeutic use advance directive." - Anonymous Online Contributor

Unverified Answer

What is the latest research for advance directives?

"There have been many milestones in clinical research with regard to Advance Directives of one's own care. Research has improved awareness of Advance Directives among patients and families. Advance Directives have been described to the public by medical professionals; most recently, the National Institute of Health Advance Directives Publication Series have been created to provide concise information regarding Advance Directives. Advanced Directives have been studied in the health care setting with regard to risk of patient non-compliance and the impact on the end-of-life care plans. Advance directives as an adjunct to care plans can enhance patient and family decision-making during complicated end-of-life situations." - Anonymous Online Contributor

Unverified Answer
Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.
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