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Eliciting Informed Goals of Care in Elderly Patients

Patient Preference | End of Life | Goals of Care

Patient-centered medical care considers a patient's values and goals for their health and well-being. Healthcare providers use this information to formulate a medical care plan that is aligned with these expectations. This shared-decision making process should occur with every medical decision, but it is especially important whenever decisions about end-of-life care are being considered. Eliciting patient preferences about resuscitation and life-support treatments in the event of life-threatening illnesses are considered to be a standard of excellent and appropriate medical care. Unfortunately, these discussions don't happen consistently and even when they do occur, are rarely ideal. The consequences can be devastating, often resulting in the delivery of unwanted medical care that can be associated with significant physical and mental suffering among patients and their families. In response to this problem, the investigators developed a novel tool to help guide these difficult conversations between healthcare providers and patients. The investigators previously tested this tool in a small group of hospitalized patients who found it acceptable and helpful. In this larger study, the investigators will compare how effective this tool is compared to usual care in ensuring hospitalized patients have their treatment preferences identified, documented and result in end-of-life care that is consistent with their preferences.

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Participation Requirements

  • Sex:

    ALL

  • Eligible Ages:

    80 and up

Participation Criteria

Inclusion Criteria:

* Hospitalized patients ≥ 80 years old with an acute medical or surgical condition admitted to any hospital ward
* Previously or currently documented CODE STATUS preferences include any life sustaining therapies
* Duration of admission ≥ 24 hours
* English speaking, or translator present
* Competent patient or substitute decision maker

Exclusion Criteria:

* Treating physician, patient, or substitute decision maker declines
* Documented resuscitation preferences for comfort or supportive care
* New diagnosis of life-limiting illness on this hospital admission, for example, new diagnosis of metastatic cancer
* Clinically unstable, admitted to an intensive care unit, or currently receiving acute life support treatment (mechanical ventilation, acute dialysis, or inotropic/vasopressor support)
* Readmission after index hospitalization
* Pre-existing need for chronic mechanical ventilation (invasive mechanical ventilation via tracheostomy \> 90 days) or maintenance dialysis (peritoneal or hemodialysis \> 90 days)

Study Location

Royal Victoria Regional Health Centre
Royal Victoria Regional Health Centre
Barrie, Ontario
Canada

Contact Study Team

Primary Contact

Kelly Cruise, BSc

[email protected]
Study Sponsored By
Royal Victoria Hospital, Canada
Participants Required
More Information
Study ID: NCT06002113