Clinical trial · Interventional
Goals of Care Conversations Study
Improving Implementation of Outpatient Goals of Care Conversations for Veterans With Serious Illness
NCT05001009CI-TRIAL-00084149LSTDIcompletedN/AResults postedClinicalTrials.gov clinicaltrialsProvenance
- Source
- ClinicalTrials.gov
- Retrieved
- Sep 17, 2026
- Layer
- normalized (units and labels harmonized; values unchanged)
- Run
- ING-CLINICALTRIALS-20260917-000001
Summary
Brief summary (as posted)
The long term goal is to improve quality of care in Veterans with serious illnesses by aligning medical care with Veterans' goals and values. The objective of this study is to use a sequentially randomized trial to determine what implementation strategies are effective to increase early, outpatient goals of care conversations. The study will use interviews with and surveys of medical providers, patients, and caregivers, along with medical record data. This work is significant because it tests ways Veterans can express their goals and preferences for life sustaining treatments and have them honored.
Conditions
Conditions (8)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
| Condition (as posted) | Mapped entity | Match | Confidence |
|---|---|---|---|
| Cancer | Malignant Neoplasm | ALIAS | 0.90 |
| Chronic Obstructive Pulmonary Disease | — | UNRESOLVED | — |
| Dementia | — | UNRESOLVED | — |
| End-stage Liver Disease | — | UNRESOLVED | — |
| End-stage Renal Disease | — | UNRESOLVED | — |
| Heart Failure | — | UNRESOLVED | — |
| Interstitial Lung Disease | — | UNRESOLVED | — |
| Seriously Ill Patients | — | UNRESOLVED | — |
Interventions
Interventions (4)
| Intervention | Type | Mapped drug | Match |
|---|---|---|---|
| Clinician Implementation Strategy Stage 1: low intensity clinician training | Behavioral | — | UNRESOLVED |
| Clinician Implementation Strategy Stage 2: high intensity clinician training | Behavioral | — | UNRESOLVED |
| High patient engagement | Behavioral | — | UNRESOLVED |
| Low patient engagement | Behavioral | — | UNRESOLVED |
Design
Arms and outcomes
Arms (4)
- type
- ACTIVE_COMPARATOR
- label
- No then high patient engagement
- description
- First stage: No patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): High patient engagement and high intensity clinician training.
- interventionNames
- Behavioral: Clinician Implementation Strategy Stage 1: low intensity clinician training
- Behavioral: Clinician Implementation Strategy Stage 2: high intensity clinician training
- Behavioral: High patient engagement
- type
- ACTIVE_COMPARATOR
- label
- No then low patient engagement
- description
- First stage: No patient engagement. Low intensity clinician training. Second stage (responders only): No patient engagement and high intensity clinician training. Second stage (non-responders only): Low intensity patient engagement and high intensity clinician training.
- interventionNames
- Behavioral: Clinician Implementation Strategy Stage 1: low intensity clinician training
Eligibility
Eligibility (as posted)
- Sex
- All
- Minimum age
- 18 Years
Show eligibility criteria text
Inclusion Criteria: CLINICIANS VA primary care advance practice clinicians (MDs, APRNs, PAs) at one of the three study sites able to complete goals of care conversation notes and orders. Advance practice clinicians will be eligible for randomization if they have at least 15 eligible patients without goals of care conversation notes at the start of stage 1 (to allow participating clinicians ample opportunities to write notes) and have written fewer than 4 goals of care conversation notes in the previous 6 months (to select clinicians who need improvement), and can potentially receive the planned implementation strategies, i.e., clinicians who regularly attend the Patient Aligned Care Team (PACT) team meetings. PATIENTS * Veteran enrolled in VHA health care in one of the three study sites who is a current patient of one of the eligible primary care clinicians * Diagnosis of cancer, heart failure, interstitial lung disease, chronic obstructive pulmonary disease, end-stage renal disease, end-stage liver disease, and dementia * Care Assessment Need score of \> or equal to 90 using the one-year combined hospitalization/mortality variable Exclusion Criteria: PATIENTS * Prisoner * Pregnant * under 18 years of age.
References
Publications (9)
- BACKGROUNDHa DM, Deng LR, Lange AV, Swigris JJ, Bekelman DB. Reliability, Validity, and Responsiveness of the DEG, a Three-Item Dyspnea Measure. J Gen Intern Med. 2022 Aug;37(10):2541-2547. doi: 10.1007/s11606-021-07307-1. Epub 2022 Jan 3. PMID 34981344
- BACKGROUNDBekelman DB, Giannitrapani K, Linn KA, Langner P, Sudore RL, Rabin B, Lorenz KA, Foglia M, Glickman A, Pawlikowski S, Sloan M, Gamboa RC, McCaa MD, Hines A, Walling AM. Increasing goals of care conversations in primary care: Study protocol for a cluster randomized, pragmatic, sequential multiple assignment randomized trial. Contemp Clin Trials. 2024 Oct;145:107643. doi: 10.1016/j.cct.2024.107643. Epub 2024 Jul 27. PMID 39074531
- BACKGROUNDHaverfield MC, Ma J, Walling A, Bekelman DB, Brown-Johnson C, Lo N, Lorenz KA, Giannitrapani KF. Communication processes in an advance care planning initiative: A socio-ecological perspective for service evaluation. Palliat Med. 2024 Dec;38(10):1134-1143. doi: 10.1177/02692163241277394. Epub 2024 Sep 10. PMID 39254148
- BACKGROUNDGambino J, Schlichte LM, Haverfield MC, Libman C, Bekelman DB, Ma JE. Uncovering Psychosocial Contexts in Goals of Care Conversations: A Qualitative Study in a Multi-Centered Randomized Controlled Trial. Clin Gerontol. 2025 Oct-Dec;48(5):1320-1327. doi: 10.1080/07317115.2025.2464023. Epub 2025 Feb 17. PMID 39957477
- BACKGROUNDLange AV, Feser WJ, Hess E, Baron AE, Ma JE, Bekelman DB. Serious Illness Communication in a Randomized Trial of a Nurse and Social Worker Palliative Telecare Team. J Am Geriatr Soc. 2025 Mar 22:10.1111/jgs.19445. doi: 10.1111/jgs.19445. Online ahead of print. PMID 40119839
- BACKGROUNDSchillok H, Gensichen J, Panagioti M, Gunn J, Junker L, Lukaschek K, Jung-Sievers C, Sterner P, Kaupe L, Dreischulte T, Ali MK, Aragones E, Bekelman DB, Herbeck Belnap B, Carney RM, Chwastiak LA, Coventry PA, Davidson KW, Ekstrand ML, Flehr A, Fletcher S, Holzel LP, Huijbregts K, Mohan V, Patel V, Richards DA, Rollman BL, Salisbury C, Simon GE, Srinivasan K, Unutzer J, van der Feltz-Cornelis CM, Wells KB, Zimmermann T, Buhner M; POKAL Group. Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis. JAMA Psychiatry. 2025 Sep 1;82(9):868-876. doi: 10.1001/jamapsychiatry.2025.0183.