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Chronic Obstructive Pulmonary DiseaseHillmanNCT05611125

Nursing-Driven Primary Palliative Care for Urban-Dwelling African Americans With Chronic Lung Disease

A study testing Telehealth Integrated Primary Care (TIPC) in people with Chronic Obstructive Pulmonary Disease, run by Thomas Jefferson University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In prior work, this research team developed a telehealth primary care model (TIPC), designed in close partnership with patients and clinicians to address a widespread increase in telehealth use during the COVID-19 pandemic. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Chronic Obstructive Pulmonary Disease
What is being tested?
Telehealth Integrated Primary Care (TIPC)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
23 participants
Where
1 siteUnited States
Study dates
2 Dec 2022to 30 Nov 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • COPD Diagnosis
  • Age 18 years or older

Who cannot join

  • Traumatic Brain Injuries
  • Incarceration
  • Homelessness
  • Developmental disorders
  • Pregnancy

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Thomas Jefferson University Hospital

    Philadelphia, Pennsylvania, 19107

Other trials in United States

About this study

In prior work, this research team developed a telehealth primary care model (TIPC), designed in close partnership with patients and clinicians to address a widespread increase in telehealth use during the COVID-19 pandemic. Researchers will test the TIPC intervention to assess palliative care (PC) support for patients with chronic obstructive pulmonary disease (COPD) among a population of urban-dwelling, African American (AA) persons over the course of 15 months.

The aims of this study are to 1) evaluate patient, caregiver, and clinical team perspectives of feasibility and acceptability of the TIPC model with urban-dwelling AAs with advanced COPD, and 2) explore the impact of TIPC intervention on knowledge and completion of advanced care planning (ACP) and on hospice and healthcare utilization patterns in the target population, as well as on additional quality of life (QOL) endpoints, and compare these between individuals participating in the intervention group and control group.

Read the detailed description

African Americans with chronic lung disease (CLD) experience higher-cost, lower-quality care (i.e. more untreated symptoms, poorer provider communication, care inconsistent with practices, lower hospice enrollment) compared to their white counterparts. Uptake of PC and ACP is also substantially lower amongst AAs and other underrepresented minorities (URMs) due to disparate access to information and mistrust in the healthcare system as generated by systemic, structural racism. Additionally, there are existing gaps in Jefferson's own PC program as revealed by our team's preliminary research into the program's level of cultural literacy. Interviews with black, indigenous people of color (BIPOC) enrolled with Jefferson PC revealed issues of clinician color blindness, an increased need for family engagement, and gaps in considering race and relationship to black pain in PC delivery.

This study will enroll 20 patients from Jefferson's Center City campuses. Half of the participants will be given the TIPC intervention, the other half will be assigned as controls who will receive their usual standard of care. All participants will be assessed over 6 months to assess changes in outcomes. Specifically amongst intervention patients, researchers will evaluate implementation outcomes (feasibility, acceptability, satisfaction, intervention uptake) of TIPC intervention at intervention start, post-visit 2, and 6 months after. Both intervention and control participants will be assessed for knowledge of ACP at 3 and 6 months, and health-related QOL, and caregiver burden at baseline, 3 months and 6 months.

Researchers will also measure clinical outcomes amongst both intervention and control patients (advance care planning and healthcare proxy designation, hospice use, avoidable healthcare utilization events) over 6 months.

Researchers will directly reach out to several departments including: Department of Medicine (Division of Pulmonary, Division of Hospital Medicine, and Division of Internal Medicine), Department of Family and Community Medicine, and Department of Emergency Medicine to identify patients (and, as applicable, their designated caregivers) for recruitment.

Once potential participants are identified, research team members will screen for eligibility criteria using EPIC. Recruitment will continue for all patients and caregivers until the anticipated enrollment goal for each group are reached (10 intervention, 10 controls).

Follow-up phone calls will be made to those who have not responded at approximately 3-7 day intervals.

Intervention subjects will partake in 2 telehealth visits as a part of the TIPC model. The first visit between patient, caregiver, and PC specialist will facilitate a patient-centered consultation guided by The Serious Illness Conversation Guide and involving patient completion of several PC assessments (i.e. Palliative Performance Scale,). The second visit between patient, caregiver, PC specialist and a pulmonology clinician/nurse will involve collaborative PC plan development and management and modeling of PC skills in an MDT framework.

This research team has trained staff to assess digital literacy and access barriers amongst all research participants. They will guide patients through accessing MyChart, creating an email (if needed), and perform test telehealth visits with patients prior to the scheduled clinical telehealth visits. If a patient is not able to connect at the time of their scheduled telehealth visit, a team member will call them via phone to again assist, as needed. This research team has ample experience with this, having created and deployed both the Telehealth Task Force (TTF) in the Sidney Kimmel Cancer Center (overseen by Dr. Worster) and the DOT (Digital Onboarding Taskforce) (overseen by Dr. Rising).

Evaluation of patient outcomes of the TIPC model will be ongoing across 6 months. Implementation outcomes will be measured amongst intervention patients. Feasibility, acceptability, and satisfaction collected via self-report will be collected at TIPC implementation and post-visit 2. Intervention uptake measured via chart review for references to the patient's PC plan in clinical encounters and PC plan-based referrals/adoptions will be analyzed over 6 months post-intervention.

Clinical outcomes will be measured for both subjects and controls. Advance care planning and healthcare proxy designation will be collected over 6 months via chart review, hospice use will be collected over 6 months via chart review for hospice enrollment and length of stay (LOS), and avoidable healthcare utilization events will be collected over 6 months via chart review for ED visits, urgent care (non-scheduled) visits, hospitalizations, and LOS with 'chief complaints' collected for each participant.

Additional follow-up outcomes of knowledge of ACP will be collected at 3 and 6 months and health-related QOL, and caregiver burden will be collected at baseline, 3 and 6 months for both subjects and controls via self-reporting.

Being tested
Telehealth Integrated Primary Care (TIPC)
Medical subject headings
Pulmonary Disease, Chronic Obstructive

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Telehealth Integrated Primary Care (TIPC)Other

    Also called TIPC

    The TIPC model of intervention incorporates video visits across research clinicians and patients' existing care clinicians for more synergized and accessible care provision for a given clinical indication. The first TIPC visit will center around the patient setting care goals for themselves and their caregiver with the help of a palliative care physician. The second TIPC visit will focus on assessing goal attainment and also close the care loop between their existing care team, a research-appointed palliative care team, and their involvement in our study.

Study groups in NCT05611125
Study groupRoleWhat they receive
InterventionExperimentalIndividuals in the intervention group will undergo a series of two telehealth video visits and a series of survey assessments at baseline, 3, and 6 months.
Receives: Other: Telehealth Integrated Primary Care (TIPC)
ControlNo interventionIndividuals in the control group will continue with their usual standard of care and undergo a series of survey assessments at baseline, 3, and 6 months.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Feasibility, Acceptability, Satisfaction regarding TIPC intervention as Assessed by Survey

    Participants in the intervention group will report their experience with the TIPC model via survey questions. Participants will indicate whether or not they strongly disagree, disagree, have no opinion, agree, or strongly agree with a series of statements asking them about their experience with TIPC intervention.

    Measured: 6 months

Secondary outcomes (11)
  1. Change in Knowledge of Advanced Care Planning (ACP)

    Participants will report the extent to which participating in video visits improved their knowledge regarding ACP. This will be assessed via a single-item statement that participants will say they either strongly disagree, disagree, have no opinion on, agree, or strongly agree with.

    Measured: 3 months

  2. Change in Knowledge of Advanced Care Planning (ACP)

    Participants will report the extent to which participating in video visits improved their knowledge regarding ACP. This will be assessed via a single-item statement that participants will say they either strongly disagree, disagree, have no opinion on, agree, or strongly agree with.

    Measured: 6 months

  3. Change in Disease-Specific Quality of Life as Assessed by the CCQ

    Participants report their disease-specific quality of life (QOL) by utilizing the Clinical COPD Questionnaire (CCQ). The CCQ measures COPD-specific QOL \& asks a variety of symptom-related questions. A summary index score is derived by applying an appropriate value set to the responses for each question (never/not limited at all=0, hardly ever/very slightly limited=0.1, a few times/slightly limited=0.2, several times/moderately limited=0.3, many times/very limited=0.4, a great many times/extremely limited=0.5, almost all the time/totally limited or unable to do=0.6). Pts can score up to 6 points with a higher score being negatively associated with a lower QOL.

    Measured: Baseline

  4. Change in Disease-Specific Quality of Life as Assessed by the CCQ

    Participants report their disease-specific quality of life (QOL) by utilizing the Clinical COPD Questionnaire (CCQ). The CCQ measures COPD-specific QOL \& asks a variety of symptom-related questions. A summary index score is derived by applying an appropriate value set to the responses for each question (never/not limited at all=0, hardly ever/very slightly limited=0.1, a few times/slightly limited=0.2, several times/moderately limited=0.3, many times/very limited=0.4, a great many times/extremely limited=0.5, almost all the time/totally limited or unable to do=0.6). Pts can score up to 6 points with a higher score being negatively associated with a lower QOL.

    Measured: 3 months

  5. Change in Disease-Specific Quality of Life as Assessed by the CCQ

    Participants report their disease-specific quality of life (QOL) by utilizing the Clinical COPD Questionnaire (CCQ). The CCQ measures COPD-specific QOL \& asks a variety of symptom-related questions. A summary index score is derived by applying an appropriate value set to the responses for each question (never/not limited at all=0, hardly ever/very slightly limited=0.1, a few times/slightly limited=0.2, several times/moderately limited=0.3, many times/very limited=0.4, a great many times/extremely limited=0.5, almost all the time/totally limited or unable to do=0.6). Pts can score up to 6 points with a higher score being negatively associated with a lower QOL.

    Measured: 6 months

  6. Change in General Quality of Life as Assessed by the FACIT-Pal

    Participants report their quality of life (QOL) by utilizing the Functional Assessment of Chronic Illness Therapy - Palliative Care (FACIT-Pal). FACIT-Pal measures areas that include physical, social/family, emotional, \& functional well-beings. A summary index score is derived by applying an appropriate value set to the responses for each question (not at all=0, a little bit=1, somewhat=2, quite a bit=3, very much=4). Pts can score up to 184 points with a higher score being associated with a higher QOL.

    Measured: Baseline

  7. Change in General Quality of Life as Assessed by the FACIT-Pal

    Participants report their quality of life (QOL) by utilizing the Functional Assessment of Chronic Illness Therapy - Palliative Care (FACIT-Pal). FACIT-Pal measures areas that include physical, social/family, emotional, \& functional well-beings. A summary index score is derived by applying an appropriate value set to the responses for each question (not at all=0, a little bit=1, somewhat=2, quite a bit=3, very much=4). Pts can score up to 184 points with a higher score being associated with a higher QOL.

    Measured: 3 months

  8. Change in General Quality of Life as Assessed by the FACIT-Pal

    Participants report their quality of life (QOL) by utilizing the Functional Assessment of Chronic Illness Therapy - Palliative Care (FACIT-Pal). FACIT-Pal measures areas that include physical, social/family, emotional, \& functional well-beings. A summary index score is derived by applying an appropriate value set to the responses for each question (not at all=0, a little bit=1, somewhat=2, quite a bit=3, very much=4). Pts can score up to 184 points with a higher score being associated with a higher QOL.

    Measured: 6 months

  9. Change in Caregiver Burden

    Participating caregivers will explore how taking care of their loved ones has impacted their daily lives via the Caregiver Strain Index (CSI). The CSI measures areas that include but are not limited to sleep hygiene, convenience of care, physical strain, family adjustments as a result of care, financial burden, and more. A summary index score is derived by applying an appropriate value set to the responses for each question (yes=1, no=0). Patients can score up to 12 points with a score of 7 or higher being associated with a higher level of caregiver burden experienced.

    Measured: Baseline

  10. Change in Caregiver Burden

    Participating caregivers will explore how taking care of their loved ones has impacted their daily lives via the Caregiver Strain Index (CSI). The CSI measures areas that include but are not limited to sleep hygiene, convenience of care, physical strain, family adjustments as a result of care, financial burden, and more. A summary index score is derived by applying an appropriate value set to the responses for each question (yes=1, no=0). Patients can score up to 12 points with a score of 7 or higher being associated with a higher level of caregiver burden experienced.

    Measured: 3 months

  11. Change in Caregiver Burden

    Participating caregivers will explore how taking care of their loved ones has impacted their daily lives via the Caregiver Strain Index (CSI). The CSI measures areas that include but are not limited to sleep hygiene, convenience of care, physical strain, family adjustments as a result of care, financial burden, and more. A summary index score is derived by applying an appropriate value set to the responses for each question (yes=1, no=0). Patients can score up to 12 points with a score of 7 or higher being associated with a higher level of caregiver burden experienced.

    Measured: 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Nov 2022
  2. Study start2 Dec 2022
  3. Primary completion30 Nov 2023
  4. Study completion30 Nov 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
23 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05611125
Sponsor's protocol ID
083-51020-U32301
Other IDs
#22G.350
Acronym
Hillman
Status last verified
Feb 2024
First submitted
27 Sep 2022
Last updated
6 Feb 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Telehealth Integrated Primary Care (TIPC) in people with Chronic Obstructive Pulmonary Disease, run by Thomas Jefferson University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Feasibility, Acceptability, Satisfaction regarding TIPC intervention as Assessed by Survey (time frame: 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Feb 2024.

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