Goals of Care Conversations Study

Summary

The long term goal is to improve quality of care in Veterans with serious illnesses by aligning medical care with Veterans' goals and values. The objective of this study is to use a sequentially randomized trial to determine what implementation strategies are effective to increase early, outpatient goals of care conversations. The study will use interviews with and surveys of medical providers, patients, and caregivers, along with medical record data. This work is significant because it tests ways Veterans can express their goals and preferences for life sustaining treatments and have them honored.

Conditions

• Seriously Ill Patients
• Cancer
• Heart Failure
• Interstitial Lung Disease
• Chronic Obstructive Pulmonary Disease
• End-stage Renal Disease
• End-stage Liver Disease
• Dementia

Interventions

BEHAVIORAL

Clinician Implementation Strategy Stage 1: low intensity clinician training

A "booster" of the established LSTDI implementation strategy. Clinicians will be presented with summary written/electronic materials on the LSTDI developed for the study. Online training options and when and how to complete goals of care conversations and documentation will be highlighted.

BEHAVIORAL

Clinician Implementation Strategy Stage 2: high intensity clinician training

This includes two components: 1. Team facilitation to help the primary care team (advance practice provider, nurse, social worker) work together to create roles and responsibilities for accomplishing goals of care conversations with patients 2. A patient list "trigger" of patients potentially eligible for goals of care conversations (the patient study population) will be sent to the primary care clinicians.

BEHAVIORAL

Low patient engagement

Patients will be sent information about goals of care conversations, including the PREPARE website.

BEHAVIORAL

High patient engagement

Patients will be sent information about goals of care conversations, including the PREPARE website. Follow-up phone calls to discuss goals of care conversations and the PREPARE website will be made.

Sponsors & Collaborators

• VA Office of Research and Development

  lead FED

Principal Investigators

• David Bekelman, MD MPH · Rocky Mountain Regional VA Medical Center, Aurora, CO

• Anne M Walling, MD PhD · VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

SEQUENTIAL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2022-09-13

Primary Completion

2024-09-30

Completion

2025-09-30

Countries

• United States

Study Locations