The Influence of Default Options in Advance Directives

University of Pennsylvania

Status: Completed

Conditions: Advance Care Planning

Treatments: Other: Advance Directive Forms

Study type: Interventional

Funder types: Other

Identifiers

NCT01346176

810894

Details and patient eligibility

About

The investigators aim to assess the influence of default options in advance directives on older patients selections of life- extending therapies and to determine whether alerting patients to the spectrum of possible default options in advance directives influences their selections of life-extending therapies by manipulating the default options of advance directives given to patients in with severe respiratory disease

Full description

The project is designed to document that default options influence terminally ill patients end-of-life decisions (in this case, adults with advance forms of lung disease) and that our team can recruit and retain patients in a study of advance care planning. In addition, because a larger-scale randomized clinical trial will require that the investigators alert participants to the range of possible default options, the investigators must also determine the effects that this alerting will have on their selections of life-extending therapies. Therefore, the investigators seek to achieve three aims: (1) assess the influence of default options in advance directives on patients selections of life-extending therapies; (2) determine whether alerting patients to the spectrum of possible default options in advance directives influences their selections of life extending therapies; and (3) document the feasibility of recruiting and retaining patients with advanced lung diseases from university-based clinical settings into a randomized trial of default options in advance directives.

Enrollment: 132 patients

Sex: All

Ages: 50+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Diagnosis of chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), non-small-cell lung cancer, or other interstitial or fibrotic lung disease
• Neither listed for nor considering solid organ transplantation
• Anticipated survival of less than 2 years
• Must be fluent and literate in English

Exclusion criteria

• Diagnosis of small-cell lung cancer or other respiratory diseases for which life extending medical therapies may be available

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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132 participants in 3 patient groups

Positive default

Experimental group

Description:

Patients in this arm will receive AD forms where specific life-extending interventions will be provided unless patients specifically opt-out from such selections

Treatment:

Other: Advance Directive Forms

Negative default

Experimental group

Description:

Patients in this arm will receive AD forms where specific life-extending interventions will not be provided unless patients specifically opt-into such selections

Treatment:

Other: Advance Directive Forms

Forced Choice

Experimental group

Description:

Patients in this arm will receive AD forms in which they must actively choose whether to receive each intervention.

Treatment:

Other: Advance Directive Forms