Improving end-of-life discussions in the Emergency Department

Shared Decision Making to Improve Goals of Care Discussions in the Emergency Department

This study is trying to create a helpful tool to improve conversations about end-of-life care in the Emergency Department for patients and their families.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 230 (estimated)
• Ages: 60 Years and up
• Sex: All
• Sponsor: Mayo Clinic (other)
• Locations: 3 sites (Scottsdale, Arizona and 2 other locations)
• Trial ID: NCT03833622 on ClinicalTrials.gov

What this trial studies

This project aims to develop and refine a shared decision-making intervention designed to enhance the quality of end-of-life discussions in the Emergency Department (ED). The approach involves gathering insights from both patients and clinicians to create a decision aid tool that facilitates these critical conversations. The process includes reviewing existing evidence, observing clinical practices, prototyping the decision aid, and conducting field tests to assess its effectiveness. The goal is to iteratively improve the tool until it is ready for broader clinical testing.

Who should consider this trial

Good fit: Ideal candidates for this study are patients aged 60 and older who are presenting to the Emergency Department and are at high risk for critical illness.

Not a fit: Patients with altered mental status, low GCS scores, or significant communication barriers may not benefit from this study.

Why it matters

Potential benefit: If successful, this intervention could lead to more effective and compassionate end-of-life care discussions for patients in emergency settings.

How similar studies have performed: Other studies have shown promise in improving end-of-life discussions through shared decision-making approaches, indicating that this method is both relevant and potentially effective.

Eligibility criteria

Inclusion:

1. Patients presenting to Mayo Clinic Rochester, Saint Marys' Emergency Department,
2. Patients at high risk for critical illness as determined by an Elderly Risk Assessment (ERA) score ≥ 16 or as determined by provider discretion,
3. ≥ 60 years of age,
4. Ability to provide informed consent,
5. Medically stable at the time of enrollment,
6. Able to participate without causing a delay in care.

Exclusion:

1. GCS scores \< 15,
2. Signs of altered mental status,
3. Known to be pregnant,
4. Incarcerated or in Police Custody,
5. Communication barriers such as visual or hearing impairment that may preclude use of the decision aid.

Where this trial is running

Scottsdale, Arizona and 2 other locations

• Mayo Clinic in Arizona — Scottsdale, Arizona, United States (NOT_YET_RECRUITING)
• Mayo Clinic in Florida — Jacksonville, Florida, United States (NOT_YET_RECRUITING)
• Mayo Clinic in Rochester — Rochester, Minnesota, United States (RECRUITING)

Study contacts

• Principal investigator: Laura E Walker — Mayo Clinic
• Study coordinator: Laura Walker

Conditions: Goals