Study protocol for Video Images about Decisions to Improve Ethical Outcomes with Palliative Care Educators (VIDEO-PCE): a pragmatic stepped wedge cluster randomised trial of older patients admitted to the hospital

IntroductionDespite the known benefit to patients and families, discussions about goals, values and preferences for medical care in advancing serious illness often do not occur. Many system and clinician factors, such as patient and clinician reticence and shortage of specialty palliative care teams...

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Published in:	BMJ open Vol. 12; no. 7; p. e065236
Main Authors:	Lakin, Joshua R, Zupanc, Sophia N, Lindvall, Charlotta, Moseley, Edward T, Das, Sophiya, Sciacca, Kate, Cabral, Howard J, Burns, Edith A, Carney, Maria T, Itty, Jennifer, Lopez, Santiago, Emmert, Kaitlin, Martin, Narda J, Lambert, Sherene, Polo, Jennifer, Sanghani, Shreya, Dugas, Julianne N, Gomez, Michele, Winter, Michael R, Wang, Na, Gabry-Kalikow, Shira, Dobie, Alexandra, Amshoff, Meredith, Cucinotta, Traci, Joel, Milton, Caruso, Lisa B, Ramirez, Ana Maria, Salerno, Kathleen, Ogunneye, Qausarat, Henault, Lori, Davis, Aretha Delight, Volandes, Angelo, Paasche-Orlow, Michael K
Format:	Journal Article
Language:	English
Published:	London British Medical Journal Publishing Group 25-07-2022 BMJ Publishing Group LTD BMJ Publishing Group
Series:	Protocol
Subjects:	Adult palliative care Alzheimer's disease Caregivers Cognitive ability Coronaviruses COVID-19 Data collection Decision making Dementia Documentation Electronic health records Ethics Hospitals Hypotheses Illnesses Intensive care Intervention Literacy Medical ethics Natural language processing Older people Palliative Care Pandemics Patients Protocols & guidelines Teachers Teams Verbal communication
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Summary:	IntroductionDespite the known benefit to patients and families, discussions about goals, values and preferences for medical care in advancing serious illness often do not occur. Many system and clinician factors, such as patient and clinician reticence and shortage of specialty palliative care teams, contribute to this lack of communication. To address this gap, we designed an intervention to promote goals-of-care conversations and palliative care referrals in the hospital setting by using trained palliative care educators and video decision aids. This paper presents the rationale, design and methods for a trial aimed at addressing barriers to goals-of-care conversations for hospitalised adults aged 65 and older and those with Alzheimer’s disease and related Dementias, regardless of age.Methods and analysisThe Video Image about Decisions to Improve Ethical Outcomes with Palliative Care Educators is a pragmatic stepped wedge, cluster randomised controlled trial, which aims to improve and extend goals-of-care conversations in the hospital setting with palliative care educators trained in serious illness communication and video decision aids. The primary outcome is the proportion of patients with goals-of-care documentation in the electronic health record. We estimate that over 9000 patients will be included.Ethics and disseminationThe Institutional Review Board (IRB) at Boston Medical Center will serve as the single IRB of record for all regulatory and ethical aspects of this trial. BMC Protocol Number: H-41482. Findings will be presented at national meetings and in publications. This trial is registered at ClinicalTrials.gov.Trial registration numberNCT04857060; ClinicalTrials.gov
Bibliography:	Protocol ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 AV and MKP-O are joint senior authors. JRL and SNZ are joint first authors.
ISSN:	2044-6055 2044-6055
DOI:	10.1136/bmjopen-2022-065236