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Advance Care Planning Evaluation in Hospitalized Elderly Patients: A Multicenter, Prospective Study

55 Years
Open (Enrolling)
Critical Illness, Chronic Obstructive Lung Disease, Congestive Heart Failure, Cirrhosis, Cancer

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Trial Information

Advance Care Planning Evaluation in Hospitalized Elderly Patients: A Multicenter, Prospective Study

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. ACP is the process by
which a person considers options about future health care decisions and identifies their
wishes. ACP has been shown to increase the quality of life of dying patients, improve the
experience of family members, and decrease health care costs.

There have been initiatives leading to the development and implementation of system-wide
strategies to increase ACP, however there has been no evaluation of the effectiveness of
these efforts from the perspective of patients and families. Many questions pertaining to
barriers and facilitators to implementation and impact of ACP on outcomes in Canada remain.

The investigators propose to conduct a perspective audit of current practice related to ACP
in elderly patients at high-risk for dying and their families. The investigators will
determine the extent to which these patients and families have engaged in ACP, what barriers
and facilitators they preceive, and how satisfied they are with communication and decision
making at the end of life. Informed by a baseline evaluation of site strengths, weaknesses
and barriers, the investigators propose to develop tailored interventions to enable
participating sites to improve their success with ACP during the entire study period. By
repeating the audit and feedback cycle annually, the investigators will enable sites to make
continuous efforts to improve their performance and be able to evaluate the effect of our
audit/feedback/tailored intervention strategy compared to baseline. Additionally, for those
patients who have engaged in ACP activities, the investigators can compare their outcomes to
those who have not.

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

Inclusion Criteria:

- 55 years or older with one or more of the following diagnoses:

- Chronic obstructive lung disease - 2 of the 4 of: baseline PaCO2 of > 45 torr,
cor pulmonale; respiratory failure episode within the preceding year; forced
expiratory volume in 1 sec <0.5 L.

- Congestive heart failure - New York Heart Association class IV symptoms and left
ventricular ejection fraction < 25%.

- Cirrhosis - confirmed by imaging studies or documentation of esophageal varices
and one of three conditions: a) hepatic coma, b) Child's class C liver disease,
or c) Child's class B liver disease with gastrointestinal bleeding.

- Cancer - metastatic cancer or stage IV lymphoma.

- End-stage dementia (inability to perform all ADLs, mutism or minimal verbal
output secondary to dementia, bed-bound state prior to acute illness) OR

- Any patient 80 years of age or older admitted to hospital from the community because
of an acute medical or surgical condition.

Exclusion Criteria:

- Non-English speaking patient/family member

- Patient with cognitive impairment

Type of Study:


Study Design:

Time Perspective: Prospective

Outcome Measure:

Extent of Implementation of ACP

Outcome Time Frame:

Year 3

Safety Issue:


Principal Investigator

Daren K Heyland, MD, MSc

Investigator Role:

Principal Investigator

Investigator Affiliation:

Queen's University


Canada: Canadian Institutes of Health Research

Study ID:




Start Date:

September 2011

Completion Date:

July 2014

Related Keywords:

  • Critical Illness
  • Chronic Obstructive Lung Disease
  • Congestive Heart Failure
  • Cirrhosis
  • Cancer
  • Advance Care Planning
  • End of life
  • Knowledge translation
  • Goals of care
  • Advance directive
  • Lining will
  • Critical Illness
  • Heart Failure
  • Liver Cirrhosis
  • Fibrosis
  • Lung Diseases
  • Pulmonary Disease, Chronic Obstructive
  • Lung Diseases, Obstructive