STAMPVA: Sharing and Talking About my Preferences
Study Details
Study Description
Brief Summary
The purpose of this study is to figure out the best way to help veterans do advance care planning. This study will examine the effects of two theory based behavior interventions by randomizing veteran into 4 groups to see which veterans will complete the 4 step process of advance care planning.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Purpose: The purpose of this study is to examine the effects of two theory-based behavior interventions on engagement of Veterans in advance care planning (ACP) by means of the following specific aim:
Primary Aim: To conduct a randomized controlled trial examining the effects of: a) usual care; b) computer-tailored intervention (CTI); c) motivational enhancement therapy (MET); d) CTI + MET on the proportion of middle-age and older Veterans receiving primary care at the VA who complete the process of ACP, defined as completing a total of 4 key ACP behaviors, including selecting a health care proxy, communicating with the proxy about goals of care, communicating with the clinician about goals of care, and documenting proxy selection and goals.
Primary Hypothesis: The proportion of Veterans completing ACP will be higher among those in each of the intervention groups compared to Veterans receiving usual care.
All of 4 groups will receive their assessments and, if, their interventions, by telephone and/or mail. The veterans will from the VA Connecticut Healthcare System. Participants will be identified through a data query of the Regional Data Warehouse who have had a primary care visit in the past 12 months. We will then be able to oversample female and minority Veterans.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Computer-tailored intervention
|
Behavioral: Computer-Tailored Intervention
CTI will receive telephone contact at three time points: baseline, two, and four months. Each contact consists of an integrated assessment and intervention feedback report, using an expert system. Participants are assessed for four different behaviors that together represent complete ACP engagement: communication with loved ones about views on quality of life versus quantity of life, communication with clinicians about views on quality of life versus quantity of life, assignment of a health care surrogate, and completion of a living will. The system takes the results of the assessment and results in an individualized feedback report.
|
| Active Comparator: Motivational Interviewing
|
Behavioral: Motivational Interviewing
MET will receive telephone contact at three time points: baseline, two, and four months. They will undergo the assessment as described above receive and they will receive a second a telephone contact within two weeks of the assessment, which will consist of an MET session. If the surrogate has been enrolled in the study, the MET will be conducted with both the Veteran and the surrogate in a dyadic telephone interview. The goal of the interview is to strengthen commitment to engage in ACP and promote self-efficacy. The interviewer will also help the Veteran to reflect on the pros and cons of ACP engagement as elicited in the assessment process, to understand how to build on ACP behaviors already engaged in, and, if appropriate, to help the Veteran create a change plan for further ACP engagement.
|
| Active Comparator: Motivational Enhancement Therapy
|
Behavioral: Motivational Enhancement Therapy
Participants assigned to CTI+MET will receive the CTI intervention at baseline, two months, and four months as described above. with a follow-up MET session as described above occurring within two weeks of each contact.
|
| No Intervention: Control Group
|
Outcome Measures
Primary Outcome Measures
- Completion of 4 ACP behaviors [6 months]
Having completed 4 ACP behaviors: living will, health care agent, communication with loved ones about quality versus quantity of life, having forms in medical record
Secondary Outcome Measures
- Movement on each of 4 ACP behaviors [6 months]
Progression in readiness to change for each of the 4 ACP behaviors described above.
Eligibility Criteria
Criteria
Inclusion Criteria:
- Veteran
---Must have seen primary care provider in the past 12 months
- Primary language is English
Exclusion Criteria:
-
Severe hearing or vision loss
-
moderate-to-severe cognitive impairment
-
active psychiatric illness
-
No regular phone or permanent address
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | VA Connecticut Healthcare System | West Haven | Connecticut | United States | 06516 |
Sponsors and Collaborators
- VA Connecticut Healthcare System
Investigators
- Principal Investigator: Terri Fried, MD, VAConnecticut Healthcare System
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- TF0025