1. Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial
- Author
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Julia S. C. Chelen, Mark Rudolph, Megan Murphy, Deepika Mohan, A. James O'Malley, Meredith MacMartin, and Amber E. Barnato
- Subjects
Advance care planning ,medicine.medical_specialty ,Quality management ,Palliative care ,050801 communication & media studies ,03 medical and health sciences ,Advance Care Planning ,0302 clinical medicine ,0508 media and communications ,Intervention (counseling) ,Acute care ,Research Methods ,Medicine ,Humans ,030212 general & internal medicine ,Video game ,Aged ,palliative care ,business.industry ,Communication ,05 social sciences ,General Medicine ,Quality Improvement ,Test (assessment) ,Clinical trial ,internal medicine ,Video Games ,Hospitalists ,Family medicine ,business ,medical education & training - Abstract
IntroductionFewer than half of all people in the USA have a documented advance care plan (ACP). Hospitalisation offers an opportunity for physicians to initiate ACP conversations. Despite expert recommendations, hospital-based physicians (hospitalists) do not routinely engage in these conversations, reserving them for the critically ill.The objective of this study is to test the effect of a novel behavioural intervention on the incidence of ACP conversations by hospitalists practicing at a stratified random sample of hospitals drawn from 220 US acute care hospitals staffed by a large, nationwide acute care physician practice with an ongoing ACP quality improvement initiative.Methods and analysisWe developedHopewell Hospitalist, a theory-based adventure video game, to modify physicians' attitudes towards ACP conversations and to increase their motivation for engaging in them. The planned study is a pragmatic stepped-wedge crossover phase III trial, testing the efficacy ofHopewell Hospitalistfor increasing ACP conversations. We will randomise 40 hospitals to the month (step) in which they receive the intervention. We aim to recruit 30 hospitalists from up to eight hospitals each step to complete the intervention, playingHopewell Hospitalistfor at least 2 hours. The primary outcome is ACP billing for patients aged 65 and older managed by participating hospitalists. We hypothesise that the intervention will increase ACP billing in the quarter after dissemination, and have 80% power to detect a 1% absolute increase and 99% power to detect a 3.5% absolute increase.Ethics and disseminationDartmouth’s Committee for the Protection of Human Subjects has approved the study protocol, which is registered on clinicaltrials.gov. We will disseminate the results through manuscripts and the trials website.Hopewell Hospitalistwill be made available on the iOS Application Store for download, free of cost, at the conclusion of the trial.Trial registration numberNCT04557930.
- Published
- 2021