Training Training Module 1:Module 1:

Study Overview, Study Overview, Background and Background and

PreparationPreparation

This training session This training session contains information contains information

regarding:regarding: BackgroundBackground Study OverviewStudy Overview Study Preparation ActivitiesStudy Preparation Activities

Coordinating Centre Coordinating Centre ContactsContacts

The ACCEPT study is coordinated centrally by the Clinical Evaluation Research Unit in Kingston, Ontario, Canada.

All queries can be directed to:Jennifer KorolProject Leader

Office: 613.548.6051Office: 613.548.6051korolj@kgh.kari.net

BackgroundBackground

The Need for ACP EvaluationThe Need for ACP Evaluation

Our health care system is under siege- an aging population, patients living longer with chronic illness, and an increasing demand for services at end of life contribute to escalating costs and utilization patterns that are unsustainable.

Advance Care Planning (ACP) may offer some assistance with reducing health care costs for older Canadians and yet, at the same time, improving quality of care.

There has been no evaluation of the effectiveness of previous ACP strategy implementation efforts from the perspective of patients and families; many questions pertaining to the barriers and facilitators to implementation and the impact of ACP on outcomes remain.

This study is not primarily about whether ACP works, it is more about how best to implement it.

Decision-makers in these and other regions need this critical feedback from end users to inform future initiatives designed to improve the quantity and quality of ACP.

We propose to conduct a prospective audit of current practice related to ACP in elderly patients at high-risk of dying.

The insights we gain from evaluating and improving ACP will be disseminated throughout Canada and other participating regions.

SignificanceSignificance This will be the first large scale evaluation of ACP

in Canada and abroad.

The results will provide information on the current successes (and challenges) of ACP which will strengthen ACP implementation efforts across the country.

By increasing the quality and quantity of ACP, we stand to make huge improvements in quality of EOL care in Canada and across the world and reduce overall health costs.

Study OverviewStudy Overview

The Research Question & The Research Question &

Study DesignStudy Design

AAdvandvancce e CCare Planning are Planning EEvaluation valuation in Hospitalized Elderly in Hospitalized Elderly PPatienatientts: s: A multicenter, prospective studyA multicenter, prospective study

The ACCEPT StudyThe ACCEPT Study

Overall goal of this study is to inform decision-makers as the best strategies to implement advance care planning (ACP).

Advance Care Planning Advance Care Planning (ACP)(ACP)

ACP is a process by which a person ACP is a process by which a person considers options about ‘future’ health considers options about ‘future’ health care decisions and identifies what his/her care decisions and identifies what his/her wishes are. wishes are.

1) Patient’s personal values & wishes related to EOL care

2) Prognosis

3) Treatment options (risks, benefits, expected outcomes)

4) Deciding on future care or goals of care

5) Documenting decisions and discussions

Primary ObjectivePrimary Objective

To determine, from the patient and families’ perspectives: Prevalence of ACP and its various

components Satisfaction with end of life

communication and decision-making

What barriers to improving the quantity and quality of ACP exist

Study DesignStudy Design This is a multicenter, prospective, design that will

involve audit of current practice, followed by several audit-feedback cycles with tailored interventions designed to improve ACP practice.

Setting: Hospitals and acute care institutions in Canada and the United States.

We will enroll patients who are at high risk of dying and/or their families (where available). We will approach consecutive, eligible patients and their family members from participating hospital units for enrollment into this study.

InterventionIntervention We will time our initial approach to patient/family member

to be after the patient has been in the hospital for at least 48 hours up until the 120th hour (i.e. between 48 – 120 hours following hospital admission) to allow for symptoms present at the time of admission to have abated enough for the patient and family to participate in an interview.

Upon enrollment, the research assistant will conduct separate interviews with patients and family caregivers so they cannot influence each other’s responses.

The research assistant will administer the questionnaires in a face‑to‑face interview.

The Implementation phase of the study will include distinct audit cycles conducted annually. Each Audit Cycle consists of a data collection/entry period followed by the generation of reports and development and implementation of action plans.

CERU

Coordinating CentreResearch Site

Procedures

Training

REDCap (data)

Benchmark reports

RecruitmentData

CollectionData Entry

Implementing Action Plans

Team ResponsibilitiesTeam Responsibilities

Study Study Preparation Preparation

ActivitiesActivities

Finding the Correct Patient Finding the Correct Patient PopulationPopulation

Focus on patients admitted Focus on patients admitted to the hospital from outside to the hospital from outside (ER, home, other hospital)(ER, home, other hospital)

Target patient units:Target patient units: General medicalGeneral medical OncologyOncology RenalRenal

We are We are NOTNOT recruiting: recruiting: ICU patients/family membersICU patients/family members Patient/family members under Patient/family members under

the palliative care servicethe palliative care service

Creating Study Creating Study AwarenessAwareness

Education of unit staff is an Education of unit staff is an important aspect to initiating the important aspect to initiating the study at your site.study at your site. In-servicesIn-services Letter of informationLetter of information Ongoing promotion to house staff residents Ongoing promotion to house staff residents

and nurses (poster)and nurses (poster) Identify research team to unit staffIdentify research team to unit staff Engage key opinion leaders and championsEngage key opinion leaders and champions

Training Module 1 Training Module 1 CompleteComplete