Enabling Advance Directive Completion by Rural Alabama Veterans: A Pilot Study Aims: The primary aim of this pilot study is to gather information on the feasibility of and refine the methos relative to a future large full-scale efficacy trial of a Nurse-Supported Advance Care Planning Intervention. The secondary specific aim of this application is to develop the nurse principal investigator's research skills and advance her towards an independent nurse investigator career within VA. Objectives: The objectives of the pilot study are to (1) test the feasibility of recruitment, randomization, and retention;(2) test the feasibility of a standardized Nurse-Supported Advance Care Planning Intervention;(3) evaluate the feasibility of the assessment process and data collection procedures;(4) evaluate the Veterans'satisfaction with the intervention and their Advance Directive decisions;and (5) evaluate preliminary effects of the Nurse-Supported Advance Care Planning Intervention. Background: The VHA mission to serve the health care needs of America's veterans assumes a veteran-centered approach - one that evolves not only from the health team's assessment of needs, but especially one that begins with the veteran's assessment of his or her own needs. Preliminary data from the Alabama Veterans Rural Health Initiative study suggest that approximately 30% of rural Alabama veterans do not have an Advance Directive and want help completing one. Rural Alabama veterans live in counties with a higher percent of African American minorities, lower levels of education, and higher family poverty rates, than the average for the US population at large. Prior studies have demonstrated that disparities in Advance Directive completion rates may be related to race, level of income, and level of education. VHA research priorities include addressing the challenges of minority health care needs and the disparities that arise in healthcare delivery. Although many studies evidence the effectiveness of education and counseling in facilitating Advance Directive completion, data are lacking that demonstrate the efficacy of resource- conservative interventions to enable Advance Directive completion by rural, southern minorities. Methods: A prospective, randomized, controlled pilot study. Fifty rura Alabama veterans who receive care at the Tuscaloosa VA Medical Center will be prospectively randomized to either the Nurse-Supported Advance Care Planning Intervention or Care-as-Usual. The Nurse-Supported Advance Care Planning Intervention is a manualized education, support, and guidance session provided by a Registered Nurse that includes information about risks, benefits, and alternatives of specific choices. The Care-as-Usual is a session with the social worker who explains what the Advance Directive is, and guides the Veteran regarding the process of completing the Advance Directive document, without providing information about risks, benefits, and alternatives of specific choices. Data related to recruitment, randomization, and retention;study completion by subjects;completeness of data collection;Veterans'satisfaction;and preliminary effects of the intervention will be collected, analyzed, and evaluated. Significance: This study supports the VHA mission to provide Veteran-centered care. It lays the groundwork to address a health care disparity related to Advance Directive completion. It provides important information needed to plan a full study of the effectiveness of a specific Nurse-Supported Advance Care Planning Intervention to facilitate Advance Directive completion by rural Alabama Veterans.
Enabling Advance Directive Completion by Rural Alabama Veterans: A Pilot Study is designed to gather information on the feasibility, and refine the methods relative to, a future large full- scale efficacy trial of a Nurse-Supported Advance Care Planning Intervention. It is a prospective, randomized, controlled trial, comparing the Nurse-Supported Advance Care Planning Enabling Intervention (EI) to Care-as-Usual (AU). The EI is a 1-hour education, support, and guidance session provided by a registered nurse that includes information about risks, benefits, and alternatives of specific treatment choices. AU care is a session with the social worker (MSW) who explains what the Advance Directive is, and guides the Veteran regarding the process of completing the Advance Directive document, without providing information about risks, benefits, and alternatives of specific treatment choices. This study will enroll 50 Veterans.
