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A Supportive Care Approach for Patients Late in Life: Creating a Sustainable Model of Systematic Care to Improve the Experience of Patients, Their Families, and Caregivers.


N/A
18 Years
N/A
Open (Enrolling)
Both
Heart Failure, Dementia, Cancer

Thank you

Trial Information

A Supportive Care Approach for Patients Late in Life: Creating a Sustainable Model of Systematic Care to Improve the Experience of Patients, Their Families, and Caregivers.


The care model includes a non-clinical care guide who establishes an ongoing, personal
relationship to hear the patient's life story and understand their goals of living. The
other team members include a social worker, marriage and family therapist, registered nurse,
chaplain, and pharmacist. The team maintains a focus on the whole person so that
non-medical as well as medical goals are established. The care guide partners with patients
and caregivers to get the right support from within Allina, from their community, and from
the family's own strengths and assets. As a result, patients and caregivers should feel
honored and supported in the process.


Inclusion Criteria:



- Potential patient has a signed consent for use of medical records in research

- Patient has a primary diagnosis of advanced cancer (stage 3 or 4), advanced heart
failure, or advanced dementia

- Patient and family are willing to participate in extensive pre-pilot procedures

Exclusion Criteria:

- Patient is actively dying or terminally ill

- Hospice eligible patients

- Non Allina network primary care provider

- Patient does not speak or read English

- Patient discharged against medical advice

- Patient carries major mental health issues as defined by Minimum Data Set standards

- Patient has active major chemical dependency

- Patient resides outside of a 25 mile radius of the Allina Commons

Type of Study:

Interventional

Study Design:

Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Supportive Care

Outcome Measure:

Patient goals and wishes honored

Outcome Time Frame:

Baseline and 2 years

Safety Issue:

No

Principal Investigator

Eric W Anderson, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Allina Health

Authority:

United States: Institutional Review Board

Study ID:

38632

NCT ID:

NCT01746446

Start Date:

October 2012

Completion Date:

December 2014

Related Keywords:

  • Heart Failure
  • Dementia
  • Cancer
  • Dementia
  • Heart Failure

Name

Location

Abbott Northwestern HospitalMinneapolis, Minnesota  55430
Walker Methodist Health CenterMinneapolis, Minnesota  
Augustana Health Care CenterMinneapolis, Minnesota