Behavioral Economics for Advance Care Options

Summary

People with life-limiting illness often receive more aggressive healthcare than desired including costly procedures that provide little medical benefit. Advance Directives (AD) can reduce this effect but various factors limit their adoption.

A randomized trial will target hospitalized patients with a serious, life limiting illness to test if the behavioral economics principles of endowment (possessing something) and focusing (featuring something important to patients) can motivate AD completion. Investigators will examine if offering patients an AD by default, in combination with framing the rationale for AD completion (emphasizing patient control or caregiver burden) improves AD completion and family conversation compared to a no-intervention group. The study hypothesis is to determine if rates of AD completion and family conversations will be highest among patients receiving the intervention focused on reduced caregiver burden; and if the two intervention groups will have higher rates of both than the control group.

The investigators suspect that a small change in how patient information is framed (endowment and focusing used in tandem) will potentially leverage large increases in AD completion and that targeting HHC patients allows AD discussions early in the disease trajectory when they can participate in care decisions.

Conditions

• End of Life Care

Interventions

BEHAVIORAL

Counseling (Care giver burden focus)

An advance directive (AD) document is provided to the patient along with counseling that focuses on care giver burden as the reason for adoption of the AD.

BEHAVIORAL

Counseling (patient autonomy focus)

An advance directive (AD) document is provided to the patient along with counseling that focuses on patient autonomy (control) as the reason for adoption of the AD.

Sponsors & Collaborators

• University of Pennsylvania

  collaborator OTHER

• Robert Wood Johnson Foundation

  collaborator OTHER

• Ascension Health

  lead INDUSTRY

Principal Investigators

• Mark E Vogel, PhD · Ascension Health

• Scott Halpern, MD, PhD · University of Pennsylvania

• Kimberly R Barber, PhD · Genesys Regional Medical Director

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

50 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2014-04-30

Primary Completion

2017-10-31

Completion

2019-10-31

Countries

• United States

Study Locations