Treatment for Malignancies

Phase-Based Progress Estimates
1
Effectiveness
1
Safety
VA Greater Los Angeles Healthcare System, West Los Angeles, CA, West Los Angeles, CA
Malignancies+14 More
Eligibility
18+
All Sexes
What conditions do you have?
Select

Study Summary

This study is evaluating whether a set of implementation strategies can increase the number of goals of care conversations in the first few days of hospitalization.

See full description

Eligible Conditions

  • Malignancies
  • End-stage Renal Disease
  • Dementia
  • Heart Failure
  • Interstitial Lung Diseases (ILD)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Seriously Ill Patients
  • End-stage Liver Disease (ESLD)

Treatment Effectiveness

Effectiveness Progress

1 of 3

Other trials for Malignancies

Study Objectives

This trial is evaluating whether Treatment will improve 1 primary outcome and 3 secondary outcomes in patients with Malignancies. Measurement will happen over the course of 6 months.

6 months
Number of goals of care conversation (LST) notes completed among clinicians
Percent of eligible patients sent a letter
Percent of eligible patients spoken to by telephone during stage 2 of the SMART
Percent of eligible patients that view the PREPARE website

Trial Safety

Safety Progress

1 of 3

Other trials for Malignancies

Trial Design

6 Treatment Groups

No then low patient engagement
1 of 6
Low then low patient engagement
1 of 6
No then no patient engagement
1 of 6
Low then no patient engagement
1 of 6
No then high patient engagement
1 of 6
Low then high patient engagement
1 of 6
Active Control

This trial requires 72 total participants across 6 different treatment groups

This trial involves 6 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.

No then low patient engagementFirst stage: No patient engagement Second stage: Low patient engagement
Low then low patient engagementFirst stage: Low patient engagement Second stage: Low patient engagement
No then no patient engagementFirst stage: No patient engagement Second stage: No patient engagement
Low then no patient engagementFirst stage: Low patient engagement Second stage: No patient engagement
No then high patient engagementFirst stage: No patient engagement Second stage: High patient engagement
Low then high patient engagementFirst stage: Low patient engagement Second stage: High patient engagement

Trial Logistics

Trial Timeline

Approximate Timeline
Screening: ~3 weeks
Treatment: Varies
Reporting: 6 months
This trial has the following approximate timeline: 3 weeks for initial screening, variable treatment timelines, and roughly 6 months for reporting.

Closest Location

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

Eligibility Criteria

This trial is for patients born any sex aged 18 and older. There are 5 eligibility criteria to participate in this trial as listed below.

Mark “yes” if the following statements are true for you:
CLINICIANS VA primary care advance practice clinicians (MDs, APRNs) at one of the three study sites able to complete LST notes and orders. Advance practice clinicians will be eligible for randomization if they have at least 15 eligible patients without LST notes at the start of stage 1 (to allow participating clinicians ample opportunities to write notes) and have written fewer than 4 LST notes in the previous year (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.
PATIENTS
Veteran enrolled in VHA health care in one of the three study sites who is a current patient of one of the eligible primary care clinicians
Diagnosis of cancer, heart failure, interstitial lung disease, chronic obstructive pulmonary disease, end-stage renal disease, end-stage liver disease, and dementia
Care Assessment Need score of > or equal to 90 using the one-year combined hospitalization/mortality variable

Patient Q&A Section

How many people get airflow obstruction, chronic a year in the United States?

"About 2 million elderly people in the United States are diagnosed with airflow obstruction, chronic every year. The leading cause of chronic airflow obstruction is cigarette smoking, but other risk factors such as asthma, COPD, and a family history of chronic airflow obstruction are common. The clinical relevance of airflow obstruction, chronic is immense." - Anonymous Online Contributor

Unverified Answer

What causes airflow obstruction, chronic?

"There is an association between parallel airflow obstruction and air-flow-mechanical characteristics in asthma and chronic airflow obstruction. Asthmatics with the parallel airflow obstruction symptom-category may be at risk for airflow-mechanical abnormalities." - Anonymous Online Contributor

Unverified Answer

Can airflow obstruction, chronic be cured?

"The use of the pulmonary function tests may be helpful in the evaluation of patients with airflow obstruction diagnosed by chest radiographs. Follow-up monitoring of pulmonary function tests is important when there is a decrease in pulmonary functions." - Anonymous Online Contributor

Unverified Answer

What are common treatments for airflow obstruction, chronic?

"Most chronic airflow obstruction is managed primarily with non-pharmacological therapies such as inhalation of corticosteroids and other agents, however, pharmacological therapies are more common. More randomized controlled trials are needed to define optimal therapy." - Anonymous Online Contributor

Unverified Answer

What are the signs of airflow obstruction, chronic?

"The presence of wheezing or nocturnal crackles is very suggestive of bronchial asthma but rarely presents in isolation and therefore, the role of the physical examination remains significant in the diagnostic process. A comprehensive history is required with an emphasis on possible exposures to allergens and smoking in the current and/or previous workplace and on respiratory symptoms such as wheezing and/or night or daytime crackles and possible cough induced by exertion, medication usage and/or fever." - Anonymous Online Contributor

Unverified Answer

What is airflow obstruction, chronic?

"Airflow obstruction, chronic is a disease of respiratory system that is characterized by reduced spirometric parameters. Long-term airflow obstruction is closely correlated with decreased life expectancy and mortality. The diagnosis and the management of airflow obstruction, chronic are the subject of on-going research." - Anonymous Online Contributor

Unverified Answer

What are the latest developments in treatment for therapeutic use?

"There have been few recent developments in the overall management of patients with emphysema, and in the recent past, research has only been concerned with the effectiveness of inhaled corticosteroids and, therefore, patients with an insufficient response to inhaled corticosteroids may be candidates for an add-on to an optimal pulmonary rehabilitation." - Anonymous Online Contributor

Unverified Answer

Has treatment proven to be more effective than a placebo?

"The data do not show that any type of treatment for chronic obstructive pulmonary disease, including bronchodilators, oxygen therapy, and the use of inhalers, had any significant impact on outcomes with respect to both health status and health-related quality of life." - Anonymous Online Contributor

Unverified Answer

What does treatment usually treat?

"In a recent study, findings support evidence that asthma is related to chronic lower airway obstruction, which leads to repeated respiratory infections and, in turn, to chronic lung disease." - Anonymous Online Contributor

Unverified Answer

Have there been any new discoveries for treating airflow obstruction, chronic?

"There have not been any new methods developed to treat airflow obstruction. There have been trials with new medicines such as theophylline, the statins, and beta-2 stimulating agonists. The most common treatment is a change of medications and some of the patients show that they can have a good improvement. Currently, there are still no known benefits with any of these treatments for airflow obstruction, chronic that can be done in a clinic. It seems like the new medicines for chronic may take a long time until they are developed and accepted. The only way to find out the benefits of any treatment is with an intervention." - Anonymous Online Contributor

Unverified Answer

Have there been other clinical trials involving treatment?

"The majority of published trials in this area failed to obtain institutional review board approval before starting enrollment. The number of published trials is still insufficient and many published trials are too small." - Anonymous Online Contributor

Unverified Answer

What is the primary cause of airflow obstruction, chronic?

"Chronic bronchitis and emphysema are the 2 major causes of airflow obstruction in COPD. The two conditions are usually associated with pulmonary dysfunction, which might partly explain the high comorbidity of COPD with asthma in a large Caucasian population. Further studies are needed to determine whether other causes of chronic airflow obstruction exist, even in the COPD population." - 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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