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Dementia |
Senility |
Clinical Trial: A Study to Tailor Advance Directives
This study is currently recruiting patients.
|
Purpose
| Condition | Intervention |
|---|---|
| Dementia Persistent Vegetative State Terminally Ill | Behavior: Advance Directive Selection |
MedlinePlus related topics: Brain Diseases; Dementia; Neurologic Diseases
Study Type: Observational
Study Design: Psychosocial, Cross-Sectional, Convenience Sample, Prospective Study
Expected Total Enrollment: 100
Study start: July 2005; Expected completion: December 2005
Last follow-up: September 2005; Data entry closure: October 2005
The purpose of this study is to assess whether patients will execute an advance directive which offers a limited trial of life-sustaining therapy in non-terminal illness, declines life-sustaining therapy or artificial nutrition in advanced dementia, or declines life-sustaining therapy in general. Advance directives (ADs) as currently drafted have been questioned since they have not had much effect on end-of-life care. However, the reason for the lack of success may be simply that they rarely apply. Traditional ADs, which are limited to terminal illness or persistent vegetative states, are difficult to apply to the more common cases of critical illness in the setting of potentially reversible disease and advanced dementia, which are often not recognized as terminal. In addition, terminal ADs are drafted too narrowly for patients who do not wish for life-sustaining therapy regardless of condition.
Patients may execute either AD at the conclusion of the survey. This research has the potential to demonstrate widely reproducible methods on which more precise advance planning can be based and thereby improve end-of-life care.
Eligibility
Accepts Healthy Volunteers
Inclusion Criteria:
- Hospitalized patients admitted to the general medical service at the University of Chicago
- Previously enrolled in a study of hospitalized general medicine patients at the University of Chicago
Exclusion Criteria:
Location and Contact Information
Illinois
The University of Chicago, Chicago, Illinois, 60637, United States; Recruiting
Elmer Abbo, M.D., Ph.D., Principal Investigator
Elmer Abbo, M.D., Ph.D., Principal Investigator, University of Chicago
David Meltzer, M.D., Ph.D., Principal Investigator, University of Chicago
More Information
Publications
[No authors listed] A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995 Nov 22-29;274(20):1591-8. Erratum in: JAMA 1996 Apr 24;275(16):1232.
Teno JM, Licks S, Lynn J, Wenger N, Connors AF Jr, Phillips RS, O''''Connor MA, Murphy DP, Fulkerson WJ, Desbiens N, Knaus WA. Do advance directives provide instructions that direct care? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc. 1997 Apr;45(4):508-12.
Teno JM, Lynn J, Phillips RS, Murphy D, Youngner SJ, Bellamy P, Connors AF Jr, Desbiens NA, Fulkerson W, Knaus WA. Do formal advance directives affect resuscitation decisions and the use of resources for seriously ill patients? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Clin Ethics. 1994 Spring;5(1):23-30. No abstract available.
Schneiderman LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD. Effects of offering advance directives on medical treatments and costs. Ann Intern Med. 1992 Oct 1;117(7):599-606.
Ditto PH, Danks JH, Smucker WD, Bookwala J, Coppola KM, Dresser R, Fagerlin A, Gready RM, Houts RM, Lockhart LK, Zyzanski S. Advance directives as acts of communication: a randomized controlled trial. Arch Intern Med. 2001 Feb 12;161(3):421-30.
Miles SH, Koepp R, Weber EP. Advance end-of-life treatment planning. A research review. Arch Intern Med. 1996 May 27;156(10):1062-8. Review.
Teno JM. Advance directives: time to move on. Ann Intern Med. 2004 Jul 20;141(2):159-60. No abstract available.
Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002 Apr 4;346(14):1061-6.
Danis M, Patrick DL, Southerland LI, Green ML. Patients'''' and families'''' preferences for medical intensive care. JAMA. 1988 Aug 12;260(6):797-802.
Starr TJ, Pearlman RA, Uhlmann RF. Quality of life and resuscitation decisions in elderly patients. J Gen Intern Med. 1986 Nov-Dec;1(6):373-9.
Silverstein MD, Stocking CB, Antel JP, Beckwith J, Roos RP, Siegler M. Amyotrophic lateral sclerosis and life-sustaining therapy: patients'''' desires for information, participation in decision making, and life-sustaining therapy. Mayo Clin Proc. 1991 Sep;66(9):906-13.
Murphy DJ, Santilli S. Elderly patients'''' preferences for long-term life support. Arch Fam Med. 1998 Sep-Oct;7(5):484-8.
Blackhall LJ, Frank G, Murphy ST, Michel V, Palmer JM, Azen SP. Ethnicity and attitudes towards life sustaining technology. Soc Sci Med. 1999 Jun;48(12):1779-89.
Gjerdingen DK, Neff JA, Wang M, Chaloner K. Older persons'''' opinions about life-sustaining procedures in the face of dementia. Arch Fam Med. 1999 Sep-Oct;8(5):421-5.
Robertson GS. Resuscitation and senility: a study of patients'''' opinions. J Med Ethics. 1993 Jun;19(2):104-7.
Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ. Advance directives for medical care--a case for greater use. N Engl J Med. 1991 Mar 28;324(13):889-95.
Lo B, McLeod GA, Saika G. Patient attitudes to discussing life-sustaining treatment. Arch Intern Med. 1986 Aug;146(8):1613-5. No abstract available.
Singer PA, Thiel EC, Salit I, Flanagan W, Naylor CD. The HIV-specific advance directive. J Gen Intern Med. 1997 Dec;12(12):729-35.
Griffith CH 3rd, Wilson JF, Emmett KR, Ramsbottom-Lucier M, Rich EC. Knowledge and experience with Alzheimer''''s disease. Relationship to resuscitation preference. Arch Fam Med. 1995 Sep;4(9):780-4.
Everhart MA, Pearlman RA. Stability of patient preferences regarding life-sustaining treatments. Chest. 1990 Jan;97(1):159-64.
Berger JT, Majerovitz D. Stability of preferences for treatment among nursing home residents. Gerontologist. 1998 Apr;38(2):217-23.
Record last reviewed: July 2005
Last Updated: July 25, 2005
Record first received: July 18, 2005
ClinicalTrials.gov Identifier: NCT00121004
Health Authority: United States: Institutional Review Board
ClinicalTrials.gov processed this record on 2005-07-26
Resources
- 2001-2002 Alzheimer’s Disease Progress Report (Alzheimer's Disease Education and Referral Center, NIA, NIH, HHS)
- AIDS - Neurological Complications (National Institute of Neurological Disorders and Stroke)
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