BOSTON Advanced directives help to clarify appropriate care for elderly nursing home residents at critical moments for their health, but the process of having the necessary conversations between residents, family members and home staff is hardly routine. With a new grant from the National Institutes of Health, Susan Mitchell, M.D., M.P.H., director of the Palliative Care Research Center in Harvard-affiliated Hebrew SeniorLife's Institute for Aging Research along with colleagues from Brown University and Massachusettes General Hospital plan a big test of whether a suite of videos can help.
"This study has enormous implications" said Dr. Mitchell. "Not only will it test a very important advance care planning intervention in a very large number of nursing homes, but it will also advance the state of the science by establishing the methodology for conducting large pragmatic trials in complex nursing home health care systems."
The videos cover a range of sensitive but important topics, including an introduction to advanced directives as well as specific situations where they are important, such as when and whether to accept a feeding tube, receive CPR, or be sent to the hospital.
"Nursing homes have an obligation to have a discussion with patients about their goals of care and it's always a difficult discussion," said Vince Mor, Ph.D., the Florence Pirce Grant Professor of Health Services Policy & Practice in the Brown University School of Medicine. "It's done relatively ad hoc without a lot of training without a lot of structure. This suite of videos provides a stimulant and a structure around which the conversation can more readily proceed."
The grant provides up to $4.5 million over five years, starting with a $500,000 pilot project in the spring. Dr. Mitchell, Dr. Mor and Angelo Volandes, M.D., M.P.H. of Massachusetts General Hospital plan to work with the Pruitt Health and Genesis nursing home chains to provide the videos in 80 nursing homes. All residents, families and workers in the homes will have access to the videos. The researchers will be most interested, however, in measuring video viewership, advanced directive adoption and, most importantly, whether hospitalizations are lower among residents either with advanced dementia, or congestive heart failure or COPD along with other conditions. That will be compared against hospitalizations among similar residents in 80 similar homes where the videos are not made available.
|Contact: Jennifer Davis|
Hebrew SeniorLife Institute for Aging Research