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Educating Dutch General Practitioners in Dementia Advance Care Planning: A Cluster Randomized Controlled Trial
Tilburgs B, Koopmans R, Vernooij-Dassen M, Adang E, Schers H, Teerenstra S, van de Pol M, Smits C et al.. Journal of the American Medical Directors Association, 2019-11-20
Topic: Risk, prevention and care in population studies
Objectives Advance care planning (ACP) is seldom initiated with people with dementia (PWD) and mainly focuses on medical end-of-life decisions. We studied the effects of an educational intervention for general practitioners (GPs) aimed at initiating and optimizing ACP, with a focus on discussing medical and nonmedical preferences of future care. Design A single-blinded cluster randomized controlled trial. Setting and participants In 2016, 38 Dutch GPs (all from different practices) completed the study. They recruited 140 PWD, aged ≥65 years at any stage and with any type of dementia, from their practice. Methods Intervention group GPs were trained in ACP, including shared decision-making and role-playing exercises. Control group GPs provided usual care. The primary outcome was ACP initiation: the proportion of PWD that had at least 1 ACP conversation documented in their medical file. Key secondary outcomes were the number of medical (ie, resuscitation, hospital admission) and nonmedical (ie, activities, social contacts) preferences discussed. At the 6-month follow-up, subjects' medical records were analyzed using random effect logistics and linear models with correction for GP clustering. Results 38 GP clusters (19 intervention; 19 control) included 140 PWD (intervention 73; control 67). Four PWD (2.9%) dropped out on the primary and key secondary outcomes. After 6 months, intervention group GPs initiated ACP with 35 PWD (49.3%), and control group GPs initiated ACP with 9 PWD (13.9%) [odds ratio (OR) 1.99; P = .002]. Intervention group GPs discussed 0.8 more medical [95% confidence interval (CI) 0.3, 1.3; P = .003] and 1.5 more nonmedical (95% CI 0.8, 2.3; P < .001) preferences per person with dementia than control group GPs. Conclusions and implications Our educational intervention increased ACP initiation, and the number of nonmedical and medical preferences discussed. This intervention has the potential to better align future care of PWD with their preferences but because of the short follow-up, the GPs' long-term adoption remains unknown.
Key findings
- Results 38 GP clusters (19 intervention; 19 control) included 140 PWD (intervention 73; control 67).
Study details
- Study designrandomized controlled trial
- Participants140
- Effect size2.9%; 49.3%; 13.9%
- Evidence strengthHigh
How this study scored 79/100
Published in a peer-reviewed journal, and it is a randomised controlled trial. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 46 of the 58 points we could judge it on, which is 79 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Medical Directors Association) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 11 / 12 | A randomised controlled trial |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 2 / 4 | 140 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 2 / 2 | Randomised and blinded or placebo-controlled (as stated in the record) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 31759901) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 46 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 46 of the 58 points we could judge it on is 79 out of 100. |
| Total | 79 / 100 | — |
What each of these 20 components measures, and what this score is not →
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APA 7th
Tilburgs, B., Koopmans, R., Vernooij-Dassen, M., Adang, E., Schers, H., Teerenstra, S., et al. (2020). Educating Dutch General Practitioners in Dementia Advance Care Planning: A Cluster Randomized Controlled Trial. Journal of the American Medical Directors Association. https://doi.org/10.1016/j.jamda.2019.09.010
Vancouver
Tilburgs B, Koopmans R, Vernooij-Dassen M, Adang E, Schers H, Teerenstra S, et al. Educating Dutch General Practitioners in Dementia Advance Care Planning: A Cluster Randomized Controlled Trial. Journal of the American Medical Directors Association. 2020. doi:10.1016/j.jamda.2019.09.010. PMID: 31759901.
BibTeX
@article{tilburgs2020-31759901,
author = {Tilburgs, B. and Koopmans, R. and Vernooij-Dassen, M. and Adang, E. and Schers, H. and Teerenstra, S. and van de Pol, M. and Smits, C. and others},
title = {{Educating Dutch General Practitioners in Dementia Advance Care Planning: A Cluster Randomized Controlled Trial}},
journal = {Journal of the American Medical Directors Association},
year = {2020},
doi = {10.1016/j.jamda.2019.09.010},
pmid = {31759901},
url = {https://doi.org/10.1016/j.jamda.2019.09.010}
}