Jumpstarting Advance Care Planning With ANAI People

Southcentral Foundation

Status: Invitation-only

Conditions: Advance Care Planning

Treatments: Behavioral: JUMPSTART-ANAI

Study type: Interventional

Funder types: Other

Identifiers

NCT06538493

5R01NR020491 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The older Alaska Native/American Indian (ANAI) population is increasing at twice the rate of the general population with a higher burden of serious illness. Older ANAI adults with serious illness are half as likely to have advance directives (AD), indicating a need for improved access to and utilization of advance care planning (ACP) to ensure that medical care aligns with the values, goals, and preferences of ANAI patients and their families throughout the illness trajectory. The major goals of this cluster randomized trial (CRT) are to (1) evaluate the comparative effectiveness of usual care and JUMPSTART- ANAI, a culturally tailored ACP communication intervention, for prompting patient-driven ACP conversations between ANAI adults and primary care providers and to (1) identify key factors to successfully implement the intervention in health systems serving ANAI adults with serious illness.

Full description

Despite a disproportionate burden of serious illness, Alaska Native and American Indian (ANAI) people are far less likely than their peers in the general US population to use palliative care, including advance care planning (ACP), which aims to align medical care with patients' values, goals, and preferences. ACP has been demonstrated to result in decreased depression, anxiety, and grief for patients and their families, increased symptom management, and fewer non-beneficial and unwanted end-of-life treatments. ACP is typically documented in advance directives (ADs) that specify patient preferences for life-sustaining treatments and who can make medical decisions on their behalf. Yet, ANAI people ages 55 and older are half as likely to have ADs as their White peers. A previous study culturally tailored and piloted an ACP communication intervention-JUMPSTART-ANAI-among 68 ANAI adults with serious illness in a Tribal health system in Alaska. This project builds on the previous study with a type 1 hybrid effectiveness-implementation trial of JUMPSTART-ANAI. The goal of this study is tailor an implementation plan for JUMPSTART-ANAI, evaluate the comparative effectiveness of the intervention and usual care for promoting patient-driven ACP communication, as measured by ADs documented in the electronic health record and identify key factors for successfully implementing JUMPSTART-ANAI in primary care systems serving ANAI adults with serious illness. Increasing access to culturally appropriate, evidence-based ACP is a high priority for Alaska Native health leaders and communities. By evaluating the effectiveness of a culturally tailored ACP intervention and tailoring implementation of the intervention for use in routine primary care, this study will generate critical information for implementing and improving palliative care services among a rapidly growing population of ANAI adults with serious illness.

Enrollment: 400 estimated patients

Sex: All

Ages: 40+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Alaska Native and/or American Indian
• Age 40 or older
• Empaneled to a Southcentral Foundation primary care provider
• Diagnosed with at least 1 serious illness (e.g., cancer, COPD, kidney disease)
• Has made 2 or more to primary care in last 12 months
• No Advance Directive documented in electronic health record

Exclusion criteria

• Cognitive impairment (≥ 2 errors) as assessed by the validated Short Portable Mental Status Questionnaire
• Not able to complete 30-minute study visit by phone or in person

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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400 participants in 3 patient groups

Jumpstart 1

Experimental group

Description:

Questionnaire on advance care planning experiences, preferences, and concerns

Treatment:

Behavioral: JUMPSTART-ANAI

Jumpstart 2

Active Comparator group

Description:

Questionnaire on advance care planning experiences, preferences, and concerns plus feedback form (patient and provider)

Treatment:

Behavioral: JUMPSTART-ANAI

Usual care

No Intervention group