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

Trial Summary

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 data supports the effectiveness of the GOCD Tool treatment for end-of-life care?

The Go Wish card game, similar to the GOCD Tool, has been shown to help people have important conversations about end-of-life care, making it easier for patients and families to express their needs and concerns. This tool has been useful in various settings, suggesting it could be effective in improving communication and planning for end-of-life care. ^{1 2 3 4 5}

Is the GOCD Tool generally safe for use in humans?

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 in healthcare settings, which can help improve patient safety. ^{6 7 8 9 10}

How does the GOCD Tool treatment differ from other end-of-life care treatments?

The GOCD Tool, similar to the Go Wish card game, is unique because it facilitates conversations about end-of-life care through an easy and engaging card game format, making it accessible for people with limited language skills and providing a simple way to express and share their care preferences. ^{1 11 12 13 14}

What is the purpose of this trial?

Patient-centered medical care considers a patient's values and goals for their health and well-being. Healthcare providers use this information to formulate a medical care plan that is aligned with these expectations. This shared-decision making process should occur with every medical decision, but it is especially important whenever decisions about end-of-life care are being considered. Eliciting patient preferences about resuscitation and life-support treatments in the event of life-threatening illnesses are considered to be a standard of excellent and appropriate medical care. Unfortunately, these discussions don't happen consistently and even when they do occur, are rarely ideal. The consequences can be devastating, often resulting in the delivery of unwanted medical care that can be associated with significant physical and mental suffering among patients and their families. In response to this problem, the investigators developed a novel tool to help guide these difficult conversations between healthcare providers and patients. The investigators previously tested this tool in a small group of hospitalized patients who found it acceptable and helpful. In this larger study, the investigators will compare how effective this tool is compared to usual care in ensuring hospitalized patients have their treatment preferences identified, documented and result in end-of-life care that is consistent with their preferences.

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

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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]

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 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]

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]

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]

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]

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 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]

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 '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]

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]

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]

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]

References

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

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

2. United States 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. [2018]

3. England pubmed.ncbi.nlm.nih.gov

Involving families in end of life care. [2019]

4. England 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. [2021]

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

Improving Care Experiences for Patients and Caregivers at End of Life: A Systematic Review. [2023]

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

Detection of adverse events in an acute geriatric hospital over a 6-year period using the Global Trigger Tool. [2021]

7. Germany 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. [2018]

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

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

9. England pubmed.ncbi.nlm.nih.gov

Assessment of the reliability of the IHI Global Trigger Tool: new perspectives from a Brazilian study. [2021]

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

Development of an adverse-event coping scale (AECS) using item response theory. [2015]

11. Ireland pubmed.ncbi.nlm.nih.gov

Are we ready to "think ahead"? Acceptability study using an innovative end of life planning tool. [2015]

12. England 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. [2019]

13. Netherlands pubmed.ncbi.nlm.nih.gov

A Knowledge Translation Project on Best Practices in End-of-life Care. [2021]

14. England pubmed.ncbi.nlm.nih.gov

Facilitation of an end-of-life care programme into practice within UK nursing care homes: A mixed-methods study. [2018]