UH3 Project: Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly (ACP PEACE)
Sponsoring Institution: Dana-Farber Cancer Institute
- Massachusetts General Hospital
- Boston Medical Center
- Duke University
- Feinstein Institute for Medical Research (Northwell Health)
- Mayo Clinic
NIH Institute Providing Oversight: National Institute on Aging (NIA)
Program Official: Marcel E. Salive (NIA)
Project Scientist: Jeri Miller (National Institute of Nursing Research [NINR])
ClinicalTrials.gov Identifier: NCT03609177
Trial Status: Recruiting
Too many older Americans with advanced cancer die every year receiving aggressive interventions at the end of life that do not reflect their values, goals, and preferences. Advance care planning (ACP) is the most consistent modifiable factor associated with better end-of-life communication and goal-concordant care. However, clinicians often do not possess the communication skills needed for high-quality ACP conversations, and patients are often unable to imagine their options for medical care to make informed decisions.
The ACP PEACE Demonstration Project is addressing this gap by developing a comprehensive ACP program that combines 2 well-tested, evidence-based complementary interventions: clinician communication skills training (VitalTalk) and patient video decision aids (ACP Decisions). This approach treats patients and clinicians as equal stakeholders, providing both with the communication skills and tools needed to optimally make informed decisions before the toughest choices arise. ACP PEACE is a pragmatic, cluster-randomized, stepped-wedge trial that will be conducted in 3 large healthcare systems. In the UG3 planning phase, the study team will establish the organization, processes, and infrastructure necessary to develop all aspects of implementing the intervention with 4,500 patients over 65 years of age with advanced cancer, and pilot-test the study protocol in one oncology clinic in each system. The study will use established electronic health record (EHR) systems at each health system to obtain outcomes. It is proposed that a higher proportion of patients in the intervention arm will complete advance care plans, have documented electronic medical orders for resuscitation preferences, be seen in palliative care consultations, and enroll in hospice.