Improving advance care planning for people with dementia

Improving Primary Care Clinician's Advance Care Planning Alzheimer's Disease and Related Dementias

This study tests a new toolkit to help doctors have better conversations about care goals with patients who have Alzheimer's and related dementias.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 120 (estimated)
• Ages: 18 Years to 99 Years
• Sex: All
• Sponsor: University of Pittsburgh (Academic / other)
• Locations: 1 site (Chapel Hill, North Carolina)
• Trial ID: NCT06565169 on ClinicalTrials.gov

What this trial studies

This project tests the Dementia Advance Care Planning (AD ACP) Toolkit intervention in primary care settings to enhance discussions about goals of care (GOC) for individuals living with Alzheimer's Disease and related dementias. Over an 18-month period, the study will compare the frequency and quality of GOC discussions between patients and primary care teams using the AD ACP Toolkit versus standard care. Secondary outcomes will assess healthcare utilization and the completion of advance care planning orders. The trial involves 20 primary clinics, with half receiving the intervention and the other half continuing usual care.

Who should consider this trial

Good fit: Ideal candidates include individuals aged 65 and older diagnosed with Alzheimer's Disease or related dementias who are receiving care from participating primary care teams.

Not a fit: Patients who are younger than 65 or do not have a diagnosis of Alzheimer's Disease or related dementias may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could significantly improve the quality of advance care planning and communication for patients with dementia, leading to better patient-centered care.

How similar studies have performed: Other studies have shown promise in improving advance care planning practices in similar populations, suggesting that this approach may be effective.

Eligibility criteria

Inclusion Criteria:

Primary care team member (PCTM) eligibility:

* Must be an MD/APP, employed at a primary care clinic within UNC HEALTH clinics with ≥60 PLwD encounters per year, who sees older adult patients, along with their associated nurses and social workers.
* Eligibility for training with AD ACP Toolkit will include the above and the provision of care at an intervention clinic.
* For Aim 3, only the trained intervention site primary care team members will be eligible for the implementation surveys or the interviews.

PLwD eligibility:

* Must be a PLwD age 65 years or older seen by either the intervention or control sites' primary care teams' MD/APP in the 18-month intervention window for Aim 1.
* PLwD will be eligible only after we confirm the presence of the AD/ADRD diagnosis.
* All PLwD with a ≥50% 5-year all-cause mortality risk seen by the PCTM MD/APP over the 18-month intervention period will be eligible for the healthcare utilization analyses in Aim 2.

Exclusion Criteria:

Primary care team member exclusion criteria:

* We will exclude primary care team members who do not care for older adults (e.g. pediatricians or lactation nurses), are employed at geriatric specialty or dementia specialty clinics, or are without a primary care panel (e.g., only urgent care).

PLwD exclusion criteria:

* Patients will be excluded if they have not been seen in the past 18 months by their primary care team, or if they do not have a diagnosis of ADRD.

Where this trial is running

Chapel Hill, North Carolina

• University of North Carolina, Chapel Hill — Chapel Hill, North Carolina, United States (Recruiting)

Study contacts

• Principal investigator: Christine E. Kistler, MD, MASc — University of Pittsburgh, Department of Medicine, Division of Geriatric Medicine
• Study coordinator: Christine E. Kistler, MD, MASc

Conditions Alzheimer Disease; Dementia; Alzheimer's Disease; Aging; Advance Care Planning; Primary Care; Goals of Care; Communication