Jumpstarting Advance Care Planning With ANAI People

Официальное название

Jumpstarting Advance Care Planning With ANAI People in Primary Care

Обзор

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.

Подробное описание

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.

Вмешательства

• Поведенческое JUMPSTART-ANAI
  Patient questionnaire about experiences, preferences, and concerns regarding ACP followed by feedback form with "tips" for initiating ACP conversation with provider at next clinical visit.

Первичные конечные точки

• Number of participants with an advance directive in the electronic health record [Срок оценки: Baseline, 3 months, 6 months, 12 months]

Вторичные конечные точки (2)

• Quality of communication [Срок оценки: Baseline, 3 months]
• Psychological distress [Срок оценки: Baseline, 3 months]

Критерии участия

Критерии включения

Age 40 or older with a qualifying serious illness condition (e.g., COPD) OR Age 65 or older (regardless of diagnosis) AND Alaska Native and/or American Indian AND Empaneled to a primary care provider AND 2 or more to primary care in last 12 months AND No advance directives documented in electronic health record

Критерии исключения

Unable to provide informed consent AND/OR Not able to complete 30-minute study visit by phone, video call, or in person

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Организация здравоохранения

Центры проведения

США · 1 центр

• Southcentral Foundation — Anchorage

Публикации

• Lillie KM, Dirks LG, Curtis JR, Candrian C, Kutner JS, Shaw JL. Culturally Adapting an Advance Care Planning Communication Intervention With American Indian and Alaska Native People in Primary Care. J Transcult Nurs. 2020 Mar;31(2):178-187. doi: 10.1177/1043659619859055. Epub 2019 Jul 1. PMID 31258037
• Shaw J, Medlock S, Singh RS, Piromalli C, Trainor JK, Johnson R, Rollolazo S, Fieldhouse C, Mortenson R, Landes SJ. Evaluating a tailored communication tool to increase advance care planning among Alaska Native and American Indian people in primary care: A type 1 hybrid effectiveness-implementation cluster randomized trial protocol. Contemp Clin Trials. 2026 Jun;165:108305. doi: 10.1016/j.cct.2026 PMID 41974413
• Singh RS, Landes SJ, Medlock S, Piromalli C, Mortenson R, Shaw J. Collaborative Implementation Planning to Jumpstart Advance Care Planning with Alaska Native and American Indian peoples in Primary Care. Res Sq [Preprint]. 2025 Sep 19:rs.3.rs-7400899. doi: 10.21203/rs.3.rs-7400899/v1. PMID 41001527

Идентификаторы

NCT: NCT06538493 · 5R01NR020491 · 5R01NR020491

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗