Advance Care Planning for Affordable Housing Residents

(R4RACP Trial)

Overseen By Kate Clouse, PhD, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Vanderbilt University

Disqualifiers: Cognitive, Auditory, Visual impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

30 Participants Needed

Trial Summary

Do I need to stop taking my current medications to join the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Advance Care Planning for Affordable Housing Residents is an effective treatment?

The available research shows that Advance Care Planning (ACP) interventions have been effective in various settings. For example, a study on patients with incurable cancer found that ACP improved the likelihood that patients' end-of-life wishes were followed. Another study highlighted the importance of ACP for patients with chronic illnesses who suffered traumatic injuries, suggesting it is crucial for ensuring their care preferences are respected. Additionally, a systematic review confirmed the overall effectiveness of ACP in different adult populations. While these studies focus on different groups, they collectively support the idea that ACP can be beneficial, including for affordable housing residents. ^{1 2 3 4 5}

What safety data exists for the advance care planning intervention?

The provided research abstracts do not specifically address safety data for the advance care planning (ACP) interventions, including Trauma-Informed Care-adapted and Checklist-guided ACP interventions. The studies focus on the implementation, effects, and methodologies of ACP in various settings, such as for patients with incurable cancer, in German nursing homes, and for people with dementia. However, they do not provide explicit safety data or evaluations of potential risks associated with these interventions. ^{1 4 6 7 8}

Is the Trauma-Informed Care-adapted and Checklist-guided ACP intervention a promising treatment for Advance Care Planning for Affordable Housing Residents?

Yes, the Trauma-Informed Care-adapted and Checklist-guided ACP intervention is promising because it helps people plan their future healthcare by understanding their values and wishes. This approach can be especially helpful for residents in affordable housing, as it supports them in making informed decisions about their care. ^{2 4 6 7 9}

What is the purpose of this trial?

Affordable housing residents continue to experience multi-faceted insecurity and advance care planning (ACP) challenges even after obtaining secure housing, resulting in significant inequities in quality of care during times of cognitive incapacity. To promote proactive planning for affordable housing residents, this proposal is for a pilot study to test a novel trauma-informed care adapted advance care planning intervention with the following aims: to test initial efficacy of the intervention on ACP outcomes (Aim 1) and determine resident perceptions of intervention acceptability, appropriateness, and feasibility and perceived implementation barriers and facilitators (Aim 2). These data will support the development of a larger scale study of ACP interventions within a resiliency-based hub model to comprehensively support whole-person care and proactive planning for times of cognitive incapacity.

Research Team

Kate Clouse, PhD, MPH

Principal Investigator

Vanderbilt University

Christian Ketel, DNP, RN, FNAP

Principal Investigator

Vanderbilt University

Eligibility Criteria

This trial is for adults over 18 living in affordable housing without a completed advance directive. It aims to help them plan for healthcare decisions if they can't make them in the future due to cognitive incapacity.

Inclusion Criteria

I am over 18, live in affordable housing, and don't have an advance directive.

Exclusion Criteria

I am able to understand and consent to participate in the study.

Inability to provide informed consent or participate in the intervention due to auditory impairment

Inability to provide informed consent or participate in the intervention due to visual impairment

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Data Collection

Participants undergo baseline data collection to assess initial conditions and readiness for the intervention

1 day

1 visit (in-person)

Intervention

Participants receive the trauma-informed care adapted advance care planning intervention followed by a brief qualitative debrief interview

1 day

1 visit (in-person)

Follow-up

Participants are monitored for implementation outcomes and advance care planning processes 30 days post-intervention

30 days

1 visit (in-person)

Treatment Details

Interventions

• Trauma-Informed Care-adapted and Checklist-guided ACP intervention

Trial Overview The study tests a new way of helping people plan their care ahead of time, using trauma-informed guidance and checklists. The goal is to see how effective this approach is and how residents feel about its usefulness and practicality.

Participant Groups

Group I: Intervention Experimental Treatment 1 Intervention

All participants will participate in this single arm study consisting of three visits: visit 1 (baseline data collection), visit 2 (intervention followed by brief qualitative debrief interview), and visit 3 (30-day follow-up data collection)

Who Is Running the Clinical Trial?

Vanderbilt University

Lead Sponsor

Trials

714

Recruited

6,143,000+

Findings from Research

The advance care planning (ACP) intervention did not significantly improve the alignment of end-of-life (EoL) care with patients' wishes compared to usual care, as reported by family members three months after the patient's death.

Despite the ACP discussions being conducted with a mean length of 57 minutes, there were no notable differences in patient satisfaction, family satisfaction, or the quality of EoL care received between the ACP and usual care groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomised controlled trial of an advance care planning intervention for patients with incurable cancer. Johnson, SB., Butow, PN., Bell, ML., et al.[2020]

Only 22% of patients with chronic illnesses had advance care planning (ACP) documentation at the time of their traumatic injury, highlighting a significant gap in preparedness for end-of-life decisions.

Younger patients, those with fewer chronic illnesses, and those with fewer hospitalizations before their injury were less likely to have ACP documentation, suggesting that targeted interventions could improve ACP completion in vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of Advance Care Planning Documentation in Patients With Underlying Chronic Illness Who Died of Traumatic Injury. Kim, J., Engelberg, RA., Downey, L., et al.[2020]

Advance care planning (ACP) interventions significantly increase the completion of advance directives and facilitate end-of-life discussions between patients and healthcare professionals, based on a systematic review of 55 randomized controlled trials.

Interventions that include communication about ACP not only enhance the completion of advance directives but also improve the alignment between patients' care preferences and the care they actually receive, suggesting a broader impact on patient satisfaction and communication quality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of advance care planning: a systematic review and meta-analysis. Houben, CHM., Spruit, MA., Groenen, MTJ., et al.[2022]

In a study involving 136 residents from three nursing homes in Germany, the implementation of an Advance Care Planning (ACP) program significantly increased the completion of advance directives (ADs), with 36% of residents in the intervention region completing new ADs compared to only 4.1% in the control region over 16.5 months.

The quality of the ADs was also improved in the intervention region, as they were more likely to include proxies, physician signatures, emergency orders, and resuscitation status, indicating that the ACP program effectively enhanced the relevance and validity of advance directives for medical decision-making.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial. In der Schmitten, J., Lex, K., Mellert, C., et al.[2021]

A systematic review of 18 studies highlighted that the effectiveness of advance care planning (ACP) interventions for vulnerable populations is significantly influenced by the skills and approach of the facilitators delivering the intervention.

Participants reported mixed experiences with ACP, emphasizing the need for a holistic and personalized approach that builds trust and addresses uncertainties in prognosis and communication about end-of-life decisions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advance care plans for vulnerable and disadvantaged adults: systematic review and narrative synthesis. Brean, SJ., Recoche, K., William, L., et al.[2023]

The community-led, peer-facilitated model for advance care planning (ACP) workshops effectively prepares facilitators through a tailored training curriculum, enhancing their ability to guide public discussions on ACP, as confirmed by evaluation data from 106 facilitators.

The model emphasizes the importance of community support and mentorship, demonstrating that engaging local organizations can significantly improve public awareness and normalize ACP conversations, ultimately fostering a culture of proactive planning for healthcare decisions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A model for community-led peer-facilitated advance care planning workshops for the public. Carter, RZ., Hassan, E., Porterfield, P., et al.[2023]

Advance care planning (ACP) is crucial for individuals with dementia, but the current evidence base is limited, with only one intervention identified that effectively changed outcomes for this population across 17 studies.

Key factors influencing ACP include the cognitive decline of patients, the preferences of family members and professionals, and the need for better education on ACP, highlighting the complexity of implementing these plans in dementia care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advance care planning for people with dementia: a review. Dening, KH., Jones, L., Sampson, EL.[2022]

Advance care planning (ACP) is crucial for residents in long-term care facilities, as it helps them express their medical preferences in case they become unable to make decisions later on.

The article outlines a three-step process for ACP: considering options and values, communicating decisions, and documenting choices, emphasizing its importance in improving the quality of care for residents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advance care planning in long-term care facilities. Cantor, MD., Pearlman, RA.[2006]

Advance Care Planning (ACP) was first implemented in Germany in the 2000s and has since been supported by legislation that allows nursing homes to offer ACP facilitation covered by health insurance, promoting care that aligns with individual preferences.

Despite the positive evaluation of ACP initiatives, there is a lack of standardized qualifications for ACP facilitators and insufficient consideration of institutional and regional factors in the legislation, which may hinder effective implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advance Care Planning in Germany. Götze, K., Feddersen, B., In der Schmitten, J., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

A randomised controlled trial of an advance care planning intervention for patients with incurable cancer. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

Predictors of Advance Care Planning Documentation in Patients With Underlying Chronic Illness Who Died of Traumatic Injury. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

Efficacy of advance care planning: a systematic review and meta-analysis. [2022]

4. Germany pubmed.ncbi.nlm.nih.gov

Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Advance care plans for vulnerable and disadvantaged adults: systematic review and narrative synthesis. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

A model for community-led peer-facilitated advance care planning workshops for the public. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Advance care planning for people with dementia: a review. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Advance care planning in long-term care facilities. [2006]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Advance Care Planning in Germany. [2023]