UH3 Project: Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly (ACP PEACE)
Overview
Principal Investigators:
Sponsoring Institution: Dana-Farber Cancer Institute
Collaborators:
- 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 Salive, MD, MPH (NIA)
Project Scientist: Karen Kehl, PhD, RN, FPCN (National Institute of Nursing Research [NINR])
ClinicalTrials.gov Identifier: NCT03609177
Trial Status: Enrolling
Trial Summary
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.
To address this gap, we have developed a Comprehensive ACP Program that combines two well-tested, evidence-based, and complementary interventions: clinician communication skills training and patient video decision aids. This inclusive ACP 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. We have shown the efficacy of the elements of the Comprehensive ACP intervention in several small randomized controlled trials for older patients with cancer. The overall objective of this proposal is to conduct a pragmatic stepped wedge cluster randomized trial (SW-CRT) in three large health care systems: Duke Health, the Mayo Clinic, and Northwell Health.
During the first UG3 year, we will establish the organization, processes, and infrastructure necessary to develop all aspects of a pragmatic SW-CRT of the intervention for 4,500 patients over 65 with advanced cancer and pilot test the study protocol in one oncology clinic in each system (Aim 1). During the four years of the UH3 stage, we will conduct a SW-CRT in 36 oncology clinics in the three systems and evaluate the effectiveness of the intervention by comparing the following outcomes: 1. Advance care plans completion; 2. Medical orders for resuscitation preferences; 3. Palliative care consultations; and 4. Hospice use (Aim 2). We will use established electronic health record systems at each health system to obtain outcomes. We hypothesize that a higher proportion of patients in the intervention phase (vs. control) will: complete advance care plans (primary trial outcome), have documented electronic medical orders for resuscitation preferences, be seen in palliative care consultations, and enroll in hospice. We will also characterize detailed patient-centered outcomes in a subgroup of 450 patients, including video declarations of individual preferences (Aim 3). Clinician communication training along with video decision support is a practical, evidence-based, and innovative approach to uniformly provide robust ACP. This work has the potential to improve the quality of care provided to millions of older Americans with cancer.
Data and Resource Sharing
- ACP PEACE-2019-UH3 Follow-up
ACP PEACE-Ethics and Regulatory UH3 Follow-up
- ACP PEACE Ethics and Regulatory Discussion
ACP PEACE Ethics and Regulatory Discussion
Featured Interview
Drs. Tulsky and Volandes discuss the ACP PEACE NIH Collaboratory Trial.
News and Interviews
- News_A Year of New Insights From the NIH Pragmatic Trials Collaboratory
December 12, 2023: A Year of New Insights From the NIH Pragmatic Trials Collaboratory
- News_Wealth of New Insights From the NIH Pragmatic Trials Collaboratory
December 13, 2022: In Our Tenth Year, a Wealth of New Insights From the NIH Pragmatic Trials Collaboratory
- Video_Update on the ACP PEACE Demonstration Project
Video Interview: Update on the ACP PEACE NIH Collaboratory Trial
- News_Biostatistics Core Develops Tools and Strategies for Common Research Challenges
August 16, 2022: Biostatistics Core Develops Tools and Strategies for Common Research Challenges
- News_Three Demonstration Projects Share Progress on Planning, Implementation, and Completion
July 26, 2022: Three NIH Collaboratory Trials Share Progress on Planning, Implementation, and Completion
- News_ACP-COVID Intervention Associated With Higher Rates of Advance Care Planning
March 24, 2022: ACP-COVID Intervention Associated With Higher Rates of Advance Care Planning
- News_A Year of New Insights From the NIH Collaboratory
December 14, 2021: A Year of New Insights From the NIH Collaboratory
- News_ACP PEACE
August 2, 2021: Can a Primary Care Telehealth Intervention Change the Paradigm for Advance Care Planning?
- News_A Year of Results and New Insights From the NIH Collaboratory
December 15, 2020: A Year of Results and New Insights From the NIH Collaboratory
- News_ACP PEACE Trial Moves From Planning to Implementation Phase
July 16, 2019: ACP PEACE Trial Moves From Planning to Implementation Phase: An Interview With Dr. Angelo Volandes
Publications
- Volandes et al JAMA Netw Open 2023
Video intervention and goals-of-care documentation in hospitalized older adults: the VIDEO-PCE randomized clinical trial
- Zupanc et al J Pain Symptom Manage 2023
Forms or free-text? Measuring advance care planning activity using electronic health records
- Murray et al J Gen Intern Med 2023
Structural barriers to well-grounded advance care planning for the seriously ill: a qualitative study of clinicians' and administrators' experiences during a pragmatic trial
- LaVine et al J Gen Intern Med 2023
Reaching ambulatory older adults with educational tools: comparative efficacy and cost of varied outreach modalities in primary care
- Marziliano et al J Gerontol A Biol Sci Med Sci
Patient factors and hospital outcomes associated with atypical presentation in hospitalized older adults with COVID-19 during the first surge of the pandemic
- Volandes et al JAMA Netw Open 2022
Association of an advance care planning video and communication intervention with documentation of advance care planning among older adults: a nonrandomized controlled trial
- Lindvall et al J Pain Symptom Manage 2021
Natural language processing to identify advance care planning documentation in a multisite pragmatic clinical trial
- Ouchi et al Ann Emerg Med 2019
Goals-of-care conversations for older adults with serious illness in the emergency department: challenges and opportunities
- Richesson et al J Am Med Inform Assoc 2021
Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory
- Lakin et al J Palliat Med 2021
A yet unrealized promise: structured advance care planning elements in the electronic health record
- El-Jawahri et al J Gen Intern Med 2021
Clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in Boston
- ACP PEACE Study Redesign
ACP PEACE Study Redesign (Details)
- Lakin et al BMJ Open 2020
ACP PEACE Study Design Paper
- Living Textbook Chapter_Which PCTs Should Have a DMC
Living Textbook Chapter: Which PCTs Should Have a DMC?
- Living Textbook_The Embedded Pragmatic Trials Ecosystem
Living Textbook: The Embedded Pragmatic Clinical Trial Ecosystem
- ACP PEACE Study Snapshot
ACP PEACE Study Snapshot
Presentations
- AcademyHealth D&I Workshop 2023_ePCTs in Context_Panel-2_Slides
AcademyHealth D&I Workshop 2023 - Panel 2
- AcademyHealth D&I Workshop 2023_ePCTs in Context_Panel-1_Slides
AcademyHealth D&I Workshop 2023 - Panel 1
- AcademyHealth D&I Workshop 2023_ACPPeace-Slides
AcademyHealth D&I Workshop 2023 - ACP PEACE
- ACP PEACE (AcademyHealth 2023)_FINAL
Case Study - ACP PEACE - AcademyHealth 2023
- 2023 AcademyHealth Workshop_Day 1_Weinfurt_ePCTs in Context
ePCTs in Context-Day 1
- SC-Mtg-2023-Day1-Tulsky-Volandes
Dr. Tulsky and Dr. Volandes Presentation at 2023 Steering Committee Meeting
- 2022 NIH Workshop_Tulsky
2022 NIH Workshop: ACP PEACE Presentation
- GR-Video-03-04-22
ACP COVID: A Trial to Evaluate an Advance Care Planning Video and Communication Skills Training Intervention for Older Adults During an Evolving Pandemic (GR Video 2022)
- GR-Slides-03-04-22
ACP COVID: A Trial to Evaluate an Advance Care Planning Video and Communication Skills Training Intervention for Older Adults During an Evolving Pandemic (GR Slides 2022)
- 12.Tulsky_5minutes_FINAL_revised
ACP PEACE Overview
- 3.-Tulsky_15mins_FINAL_revised
ACP PEACE Update
- SC-2019-UG3-ACP-PEACE
UG3 Updates-ACP PEACE
- GR-Video-02-01-19
Promoting Effective Advance Care Planning Communication in the Elderly: The ACP-PEACE Trial (GR Video 2019)
- GR-Slides-02-01-19
Promoting Effective Advance Care Planning Communication in the Elderly: The ACP-PEACE Trial (GR Slides 2019)