CURRENT RESEARCH ACTIVITIES

One key feature of an effective advance care planning program is a commitment to continuous quality improvement. The Respecting Choices program received national recognition with the publication of the La Crosse Advance Directive Study.  Respecting Choices faculty continue to be actively involved in research initiatives and welcome opportunities to consult with research partners.

Here is a summary of our current research initiatives:

1. Converting Treatment Wishes into Orders at the End of Life.  This is a retrospective study funded by The National Institute of Nursing Research looking at long term residents’ care in Oregon, West Virginia, and Wisconsin. The aim is to determine the use and effectiveness of the unique form Physicians Orders for Life-Sustaining Treatment (POLST).  (For more information about POLST go to www.polst.org) The study is being lead by Susan Hickman, Ph.D. from the Oregon Health and Science University (OHSU) School of Nursing. Susan Tolle, MD from OHSU is a co-investigator. Alvin Moss, MD, is the site investigator in West Virginia and Bud Hammes, Ph.D. is the site investigator in Wisconsin. In this study all nursing homes in each state will first be contacted to determine their use of advance directives and the POLST form. Then 30 nursing homes in each state will be included in a chart review, 15 facilities being high users of POLST and 15 facilities being low or no users of POLST. At each nursing home 20 charts will be randomly selected for data collection regarding care related to end-of–life care. Results from the study are expected in the summer of 2008.

2. A Patient-Centered Approach to Advance Care Planning in Patients with End-Stage Heart Failure and End-Stage Renal Disease (HSC Protocol #2003-165). This is a randomized, control study at multiple sites to test if the Respecting Choices Patient-Centered Advance Care Planning (PCACP) intervention results in improved short and long term outcomes than the current standard of care for patients with end-stage CHF and ESRD. The funding is from the Agency for Healthcare Research and Quality and the Principal Investigator is Karin Kirchhoff, PhD from the University of Wisconsin, Madison. Bud Hammes is Co-investigator and Linda Briggs is a Project Director and responsible for the training of the interventionists delivering the PCACP intervention.

3. Related to the above study, Linda is conducting an investigation to study the perspectives of the interventionists conducting the PCACP intervention, i.e. Exploring Advance Care Planning Facilitators' Perspectives on Assisting Patients with End-of-Life Decision Making. A series of focus group interviews are being conducted at various times throughout the 2 ½ year recruitment period.

4. Maureen Lyon, PhD from the Children's Research Institute in Washington DC is another research partner. She has received funding to implement her study Shared Decision Making in Adolescents with HIV. This study will adapt and integrate 3 existing interventions into one family solving intervention to address complex medical treatment and end-of-life care to improve outcomes for HIV infected adolescents and their families. One of the existing interventions is the Respecting Choices PCACP interview. Linda is a Co-investigator on this study and is responsible for training the interventionists in the skills of delivering the PCACP intervention.