Research

Gloria Bonner , PhD, RN, Funded Projects

Advanced Care Treatment Plans (ACT-Plan) for African American Family Caregivers

Funding Source: National Institute of Nursing Research

Dates: 7/20/07– 5/31/10

Co-Investigators: Barbara Dancy, Edward Wang, Diana Wilkie, Carol Ferrans

Abstract: Advance care treatment plans made before the end of life (EOL) for relatives with dementia save families anguish in times of medical crises, but less than 9% of African Americans (AAs) have made them. Yet, AAs have high morbidity and mortality rates from dementia. We propose a community-based pilot study examining the feasibility of an Advance Care Teatment Plan (ACT-Plan) intervention to help AA caregivers make EOL health care choices about cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), and tube feeding (TF). ACT-Plan, a 4-week education program, emphasizes storytelling, case studies, self-reflection, and guided discussions as strategies to teach knowledge, self-efficacy, and behavioral skills related to EOL advance care treatment plans. In a pretest and 4-week posttest, two-condition randomized design, 64 caregivers will be assigned to either ACT-Plan or attention control groups at different sites respectively and asked to complete questionnaires and an interview. Specific aims are to describe: 1) protocol adherence (attrition rate, attendance, instrument completion); 2) change in caregivers' outcomes: (a) knowledge about dementia, CPR, MV, and TF; (b) self-efficacy regarding their advance care decisions about CPR, MV, and TF; and (c) decision to develop an advance care plan for relatives diagnosed with dementia. We expect that 85% of the subjects will be retained; 80% will attend all four sessions; 80% will arrive on time for all four sessions; and 100% will have completed at least 80% of the items at pretest and posttest on each instrument. Comparing pretest and posttest values within groups, we expect an increase in knowledge, self-efficacy, and decision to develop advance care plans for the ACT-Plan condition but not for the attention control condition.