GOCD Tool for End of Life Care

(ASKMEGOC Trial)

Overseen By Kelly Cruise, BHSc

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Royal Victoria Hospital, Canada

Disqualifiers: Life-limiting illness, ICU, others

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

Compensation: Varies

Number of Visits: Unknown

1200 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests the GOCD Tool, created to facilitate clear conversations between doctors and patients about end-of-life care. It aims to ensure that patients' treatment preferences are identified and respected by comparing the new tool to usual care practices. The trial seeks hospitalized patients aged 80 or older who have previously discussed life-sustaining treatments and can communicate in English or have a translator. As an unphased trial, it offers patients the chance to contribute to enhancing communication about end-of-life care.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on end-of-life care discussions rather than medication changes.

What prior data suggests that this tool is safe for end-of-life care discussions?

Research has shown that the GOCD Tool has been tested with small groups of hospital patients, who found it both acceptable and helpful. Although specific safety data for the GOCD Tool itself is lacking, similar tools used for discussing care goals have not raised any safety concerns.

Because the GOCD Tool is neither a medication nor a procedure that involves entering the body, it is generally considered safe for use. It facilitates discussions between doctors and patients about preferences for end-of-life care. No reports of physical side effects or negative events have been directly linked to its use. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the GOCD Tool for end-of-life care because it introduces a web-based shared-decision making software for facilitating goals-of-care discussions in intensive care units. Unlike the traditional approach where physicians conduct these important conversations directly with patients, the GOCD Tool provides a structured, digital platform to support decision-making. This method aims to enhance communication, ensure patient preferences are clearly understood and respected, and potentially improve overall patient satisfaction with their care during such a critical time.

What evidence suggests that the GOCD Tool is effective for end-of-life care?

Research shows that discussing end-of-life care aligns patient preferences with the treatments they receive, reducing unwanted treatments and suffering. In this trial, participants will either use the GOCD Tool, a web-based shared-decision-making software, or engage in usual care discussions with an attending physician. Studies have found that tools like the GOCD Tool help ensure patient wishes are recorded and followed. Both patients and healthcare providers find these tools useful and acceptable. Early feedback from a small group suggests the GOCD Tool effectively makes these discussions more meaningful and aligned with patient desires. ^{2 6 7 8 9}

Who Is on the Research Team?

Giulio Didiodato, MD

Principal Investigator

Royal Victoria Regional Health Centre

Chris Martin, MD

Principal Investigator

Royal Victoria Regional Health Centre

Doug Austgarden, MD

Principal Investigator

Royal Victoria Regional Health Centre

Are You a Good Fit for This Trial?

This trial is for hospitalized patients who are at least 80 years old, facing serious medical or surgical conditions, and can make decisions for themselves or have someone to do it for them. They must be able to communicate in English or have a translator available.

Inclusion Criteria

I am 80 or older and was admitted to the hospital for an acute condition.

I was admitted to the hospital for at least 24 hours.

I speak English or have a translator available.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Intervention

Facilitated Goals of Care Discussions (GOCDs) using a web-based shared-decision making tool

During index hospitalization

In-hospital discussions

Follow-up

Participants are monitored for outcomes such as ICU days, ventilator use, and dialysis days up to 12 months post-admission

12 months

Evaluation

Evaluation of patient satisfaction and quality of communication regarding the GOCD tool

During index hospitalization

What Are the Treatments Tested in This Trial?

Interventions

• GOCD Tool

Trial Overview The study is testing a new tool called the GOCD Tool against usual care practices to see if it better captures and respects elderly patients' end-of-life treatment preferences during hospital stays.

How Is the Trial Designed?

Group I: GOCD Tool Experimental Treatment 1 Intervention

Intensive care unit-facilitated goals-of-care discussion using web-based shared-decision making software tool

Group II: usual care Active Control 1 Intervention

Usual discussions conducted by attending physician with patient

Who Is Running the Clinical Trial?

Royal Victoria Hospital, Canada

Lead Sponsor

Trials

18

Recruited

10,400+

Alectra

Collaborator

Trials

1

Recruited

1,200+

Royal Victoria Foundation

Collaborator

Trials

1

Recruited

1,200+

Royal Victoria Regional Health Centre

Collaborator

Trials

3

Recruited

1,400+

Published Research Related to This Trial

In a 6-year study of 1,440 geriatric patients, 424 adverse events (AEs) were identified, with a significant portion (65.8%) deemed preventable, highlighting a critical area for improving patient safety in acute care settings.

The study observed a significant reduction in the rate of AEs and high-severity events over time, likely due to interventions such as staff training, improved patient identification, and the use of electronic records, indicating effective strategies for enhancing safety in geriatric care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Detection of adverse events in an acute geriatric hospital over a 6-year period using the Global Trigger Tool. Suarez, C., Menendez, MD., Alonso, J., et al.[2021]

A new tool for clinicians in inpatient oncology units has been developed to prevent adverse events and enhance patient safety, focusing specifically on cancer patients.

The tool includes a catalog of adverse events and a risk map, which helps healthcare providers implement best practices in their daily activities to improve clinical safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving patient safety in the inpatient setting through risk assessment and mitigation. Reche Navarro, MN.[2016]

The Go Wish card game is an effective and accessible tool for facilitating conversations about end-of-life care, particularly for low-functioning assisted-living residents and their families, requiring minimal instruction for use.

This tool not only helps articulate patients' needs and concerns but has also proven to be widely applicable across various settings, making it a cost-effective option for advance care planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Go Wish: a tool for end-of-life care conversations. Menkin, ES.[2007]

The study identified three facilitation approaches for implementing the Gold Standards Framework in Care Homes (GSFCH) program, with 'being present' facilitation being the most effective in helping nursing homes complete the program and achieve accreditation.

Successful implementation of the GSFCH program required not just presence but also mastery and commitment from all participants, indicating that effective facilitation can lead to cost savings that outweigh the costs of support provided.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Facilitation of an end-of-life care programme into practice within UK nursing care homes: A mixed-methods study. Kinley, J., Preston, N., Froggatt, K.[2018]

The Go Wish intervention aims to facilitate discussions about end-of-life care preferences among patients with chronic progressive diseases, potentially reducing health-related anxiety during advance care planning.

This study will involve 135 patients across three groups to evaluate the effectiveness of the Go Wish intervention compared to standard care, measuring outcomes like advance directive completion, anxiety levels, and quality of communication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nurse-led patient-centred intervention to increase written advance directives for outpatients in early-stage palliative care: study protocol for a randomised controlled trial with an embedded explanatory qualitative study. Iglesias, K., Busnel, C., Dufour, F., et al.[2021]

In a study of 235 patients requiring palliative care, 24.68% experienced adverse drug events (ADEs), with 30.26% of these ADEs directly related to hospitalization.

Most ADEs (94.45%) were deemed preventable, highlighting the need for better medication management, especially in patients with extreme polypharmacy (10 or more medications) and high treatment complexity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse drug events in patients with advanced chronic conditions who have a prognosis of limited life expectancy at hospital admission. Sevilla-Sanchez, D., Molist-Brunet, N., Amblàs-Novellas, J., et al.[2018]

The study developed an Adverse-Event Coping Scale (AECS) based on responses from 140 patients, demonstrating good reliability (coefficient of 0.82) and a one-dimensional structure with 11 items.

Higher AECS scores indicate that patients are facing serious adverse drug events (ADEs) and are making significant efforts to cope, which can help clinicians identify when timely interventions are needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of an adverse-event coping scale (AECS) using item response theory. Park, T., Hadsall, RS., Schommer, JC., et al.[2015]

The initiative at North Tees and Hartlepool NHS Foundation Trust involves family members of dying patients keeping diaries to provide feedback on care, which helps identify and address issues in end-of-life care.

The collected data is audited and shared with clinical staff and managers to improve patient-reported outcomes and ensure quality markers for achieving a 'good death' for patients on the Liverpool Care Pathway.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Involving families in end of life care. Smith, S., Pugh, E., McEvoy, M.[2019]

The 'Think Ahead' end-of-life planning tool was well-received by 100 clinically stable patients in a study, with 92% completing follow-up surveys indicating high acceptability and positive experiences.

The tool effectively encouraged discussions about end-of-life issues among families, with 83% of participants engaging in conversations, suggesting it could be beneficial for broader use in general practice settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Are we ready to "think ahead"? Acceptability study using an innovative end of life planning tool. O'Shea, B., Martin, D., Brennan, B., et al.[2015]

A toolkit designed to enhance end-of-life care practices has been developed for use within electronic medical records (EMRs) in British Columbia, promoting better care through co-design with primary care providers.

Initial feedback from the first three phases of the project has been positive, indicating that the toolkit is effective and leading to ongoing improvements in its design and functionality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Knowledge Translation Project on Best Practices in End-of-life Care. Lau, F., Barwich, D., Hilliard, N., et al.[2021]

A review of 84 articles identified 16 that focused on improving end-of-life care experiences for patients and caregivers, primarily in palliative care settings, highlighting the need for more research in hospice care.

Current efforts to enhance end-of-life care experiences show mixed results and lack comprehensive strategies, indicating a gap in understanding how to effectively improve specific aspects of care, such as communication and support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Care Experiences for Patients and Caregivers at End of Life: A Systematic Review. Quigley, DD., McCleskey, SG.[2023]

The study found that the reliability of the IHI-GTT tool for identifying adverse events (AEs) varied significantly based on the method of analysis, with medical students showing a higher agreement (Kappa = 0.76) compared to nurses (Kappa = 0.17) when identifying AEs.

Overall, the findings suggest that advanced medical students can effectively participate in the review process for AEs in healthcare settings, especially where staffing shortages exist, but further research is needed to understand the implications of the varying reliability in AE identification.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of the reliability of the IHI Global Trigger Tool: new perspectives from a Brazilian study. Moraes, SM., Ferrari, TCA., Figueiredo, NMP., et al.[2021]

Implementing the Gold Standards Framework for Care Homes and an adapted Liverpool Care Pathway in seven nursing homes in Scotland led to a significant increase in the use of Do Not Attempt Resuscitation (DNAR) documentation and advance care planning.

The program also resulted in a reduction of unnecessary hospital admissions and a decrease in hospital deaths from 15% to 8%, indicating improved end-of-life care for residents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The integrated implementation of two end-of-life care tools in nursing care homes in the UK: an in-depth evaluation. Hockley, J., Watson, J., Oxenham, D., et al.[2019]

The CaregiverVoice survey, which combines two validated questionnaires, successfully captured feedback from 330 bereaved caregivers about end-of-life care experiences, indicating its feasibility for measuring care across different settings.

Most caregivers rated the end-of-life services as excellent or very good, but 13% reported poor pain management in the last week of life, highlighting areas that need improvement in EOL care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The CaregiverVoice Survey: A Pilot Study Surveying Bereaved Caregivers To Measure the Caregiver and Patient Experience at End of Life. Seow, H., Bainbridge, D., Bryant, D., et al.[2018]

Citations

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GOCD Tool for End of Life Care (ASKMEGOC Trial) There is no specific safety data available for the GOCD Tool itself, but studies on similar tools like the Global Trigger Tool focus on detecting adverse events ...

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Advance care planning and goals of care discussions There are research tools14,15 to quantify ACP readiness and assess a person's stage in behaviour change, but in the absence of a standard clinical tool, one ...

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An umbrella review of patient- and carer-reported ... This umbrella review synthesizes evidence on measures for EOL outcomes—quality of life (QOL), care experience, quality of dying (QOD), and ...

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Factors Associated with Costly Hospital Care among ... The aims of this study were to: 1) test the hypothesis that early goals-of-care discussion (GOCD) is associated with hospitalization costs among ...

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Making the Case for Palliative Care at the System Level 65 Finally, system-level outcomes to evaluate the effect of palliative and end-of-life care interventions include measurements of healthcare utilization and ...