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The BEACON trial (Best Practices for End-of-Life Care for Our Nations' Veterans) was a six-site implementation study to evaluate a multi-component, education-based intervention to improve the quality of end-of-life care provided in VA Medical Centers.
The BEACON trial (Best Practices for End-of-Life Care for Our Nations' Veterans) was a six-site, real-world implementation trial of a multi-component, education-based intervention to improve the quality of end-of-life care conducted in VA Medical Centers (VAMCs).
The primary aim was to evaluate the effectiveness of a multi-component intervention for improving processes of care provided in the last days of life in VAMCs. The second aim was to conduct after-death interviews with next-of-kin and qualitative analysis of their perceptions of the care provided to the veteran and family.
The multi-component intervention targeted VAMC inpatient providers, including physician, nursing, and ancillary staff. It consisted of preparatory site visits, a staff training program, a newly developed Comfort Care order set decision support tool built into the CPRS, and follow-up consultation. The intervention team travelled to each site to conduct two weeks of comprehensive in-service training. Staff were trained to identify actively-dying patients and implement a set of best practices of traditionally home-based hospice care for dying patients. The team provided assistance with policies, procedures, and skill training needed to implement comfort care interventions. Introduction of the intervention at each VAMC was staggered across time at six-month intervals using a multiple-baseline, stepped wedge design.
Data on processes of end-of-life care (last 7 days) were abstracted from the CPRS medical records of all veterans who died before, during, and after the intervention (January 2005-February 2011). A priori, five processes of care were identified as primary endpoints to indicate quality of end-of-life care: 1) presence of an order for opioid pain medication at time of death; 2) a do-not-resuscitate (DNR) order in place at time of death; 3) location of death; 4) presence of enteral feeding tube or intravenous line at time of death; and 5) physical restraints in place at or near time of death.
In addition, in-depth, face-to-face interviews were conducted with 78 bereaved next-of-kin.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Arm 1 | Experimental | Comfort care education intervention, consisting of intensive, on-site staff training together with an electronic order set for palliative care and educational materials |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Comfort care education intervention | Behavioral | Comfort care education intervention, consisting of intensive, on-site staff training together with an electronic order set for palliative care and educational materials |
| Measure | Description | Time Frame |
|---|---|---|
| Presence of Order for Opioid Pain Medication | Presence of order for opioid pain medication at time of death based on abstraction of electronic medical record | Pre and Post Intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Do Not Resuscitate Order | Presence of a Do Not Resuscitate order at time of death based on abstraction of electronic medical record | Pre and Post Intervention |
| Number of Patients Who Died in ICU |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Kathryn L Burgio, PhD MA BA | Birmingham, Alabama VA Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Birmingham VA Medical Center | Birmingham | Alabama | 35233 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18705168 | Background | Williams BR, Woodby LL, Bailey FA, Burgio KL. Identifying and responding to ethical and methodological issues in after-death interviews with next-of-kin. Death Stud. 2008;32(3):197-236. doi: 10.1080/07481180701881297. | |
| 21393618 | Background | Woodby LL, Williams BR, Wittich AR, Burgio KL. Expanding the notion of researcher distress: the cumulative effects of coding. Qual Health Res. 2011 Jun;21(6):830-8. doi: 10.1177/1049732311402095. Epub 2011 Mar 10. |
| Label | URL |
|---|---|
| Growthhouse website MegaSearch, an international clearing house for high quality educational materials related to hospice and palliative care | View source |
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The BEACON trial implemented an intervention to improve quality of care at end of life. Six Veterans Administration Hospitals received the intervention in a pre-post design. Outcomes were abstracted for 6066 individuals who died either pre or post intervention. 78 next-of-kin were enrolled under protocol to conduct qualitative interviews.
The BEACON trial implemented an intervention to improve quality of care at end of life. Six Veterans Administration Hospitals received the intervention in a pre-post design. Outcomes were abstracted for 6066 individuals who died either pre or post intervention. 78 next-of-kin were enrolled under protocol to conduct qualitative interviews.
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| ID | Title | Description |
|---|---|---|
| FG000 | BEACON Intervention | Comfort care education intervention, consisting of intensive, on-site staff training together with an electronic order set for palliative care and educational materials Comfort care education intervention: Comfort care education intervention, consisting of intensive, on-site staff training together with an electronic order set for palliative care and educational materials |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
Deceased veterans
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| ID | Title | Description |
|---|---|---|
| BG000 | Arm 1 | Comfort care education intervention, consisting of on-site staff training together with an electronic order set for palliative care and educational materials Comfort care education intervention: Comfort care education intervention, consisting of on-site staff training together with an electronic order set for palliative care and educational materials |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Presence of Order for Opioid Pain Medication | Presence of order for opioid pain medication at time of death based on abstraction of electronic medical record | Posted | Number | participants | Pre and Post Intervention |
|
Adverse and Serious Event data were not collected.
All observations were retrospectively collected from electronic records to examine standard of care at the end of life. Therefore, the total number of individuals at risk is 0 because serious and adverse effects were not collected on the 6066 deceased individuals for whom electronic records were abstracted.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Arm 1 | Arm 1: Comfort care education intervention, consisting of intensive, on-site staff training |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Kathryn L. Burgio, PhD | Birmingham VA Medical Center | 205-558-7064 | kburgio@uabmc.edu |
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| ID | Term |
|---|---|
| D003643 | Death |
| D010146 | Pain |
| D004417 | Dyspnea |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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Location of death (ICU vs. other) based on abstraction of electronic medical record
| Pre and Post Intervention |
| Individuals With a Nasogastric Tube | Presence of nasogastric tube based on abstraction of electronic medical record | Pre and Post Intervention |
| Individuals With an Intravenous Line | Presence of intravenous line infusing at time of death based on abstraction of electronic medical record | Pre and Post Intervention |
| Number of Individuals Who Died in Restraints | Presence of restraints at or near time of death at time of death based on abstraction of electronic medical record | Pre and Post Intervention |
| Individuals Administered of Opioid Medication | Administration of opioid medication based on abstraction of medical record | Pre and Post Intervention |
| Individuals With an Order for Antipsychotic Medication | Order for antipsychotic medication based on abstraction of medical record | Pre and Post Intervention |
| Individuals Administered Antipsychotic Medication | Administration of antipsychotic medication based on abstraction of medical record | Pre and Post Intervention |
| Individuals With an Order for Benzodiazepine Medication | Order for benzodiazepine medication based on abstraction of medical record | Pre and Post Intervention |
| Individuals Who Received Benzodiazepine Medication | Administration of benzodiazepine medication based on abstraction of medical record | Pre and Post Intervention |
| Individuals Who Received Scopolamine | Administration of scopolamine (for death rattle) based on abstraction of medical record | Pre and Post Intervention |
| Sublingual Administration | Sublingual administration of medication based on abstraction of medical record | Pre and Post Intervention |
| Individuals With Pastoral Care Visit | Pastoral Care Visit based on abstraction of medical record | Pre and Post Intervention |
| Individuals With an Advance Directive | Presence of advance directive based on abstraction of medical record | Pre and Post Intervention |
| Individuals With a Palliative Care Consultation | Palliative Care Consultation based on abstraction of medical record | Pre and Post Intervention |
| 22765968 | Result | Bailey FA, Williams BR, Goode PS, Woodby LL, Redden DT, Johnson TM 2nd, Taylor JW, Burgio KL. Opioid pain medication orders and administration in the last days of life. J Pain Symptom Manage. 2012 Nov;44(5):681-91. doi: 10.1016/j.jpainsymman.2011.11.006. Epub 2012 Jul 4. |
| 22536938 | Result | Bailey FA, Allen RS, Williams BR, Goode PS, Granstaff S, Redden DT, Burgio KL. Do-not-resuscitate orders in the last days of life. J Palliat Med. 2012 Jul;15(7):751-9. doi: 10.1089/jpm.2011.0321. Epub 2012 Apr 26. |
| 31792872 | Derived | Bickel KE, Kennedy R, Levy C, Burgio KL, Bailey FA. The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis. J Gen Intern Med. 2020 Feb;35(2):505-513. doi: 10.1007/s11606-019-05538-x. Epub 2019 Dec 2. |
| 24655157 | Derived | Riggs JS, Woodby LL, Burgio KL, Bailey FA, Williams BR. "Don't get weak in your compassion": bereaved next of kin's suggestions for improving end-of-life care in Veterans Affairs Medical Centers. J Am Geriatr Soc. 2014 Apr;62(4):642-8. doi: 10.1111/jgs.12764. Epub 2014 Mar 21. |
| 24449032 | Derived | Bailey FA, Williams BR, Woodby LL, Goode PS, Redden DT, Houston TK, Granstaff US, Johnson TM 2nd, Pennypacker LC, Haddock KS, Painter JM, Spencer JM, Hartney T, Burgio KL. Intervention to improve care at life's end in inpatient settings: the BEACON trial. J Gen Intern Med. 2014 Jun;29(6):836-43. doi: 10.1007/s11606-013-2724-6. |
| years |
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| Gender | The total numbers of participants with gender reported is 5921 which differs from the 6066 participant total previously reported. All outcomes and demogaphics for participants were collected by examination of VA electronic records. Gender could not not identified for 145 participants. | Number | participants |
|
| Race/Ethnicity, Customized | The total numbers of participants with race/ethnicity reported is 5423 which differs from the 6066 participant total previously reported. All outcomes and demogaphics for participants were collected by examination of VA electronic records. Race/ethnicity could not be identified from electronic records for 643 participants. | Number | participants |
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| Secondary | Do Not Resuscitate Order | Presence of a Do Not Resuscitate order at time of death based on abstraction of electronic medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Number of Patients Who Died in ICU | Location of death (ICU vs. other) based on abstraction of electronic medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals With a Nasogastric Tube | Presence of nasogastric tube based on abstraction of electronic medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals With an Intravenous Line | Presence of intravenous line infusing at time of death based on abstraction of electronic medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Number of Individuals Who Died in Restraints | Presence of restraints at or near time of death at time of death based on abstraction of electronic medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals Administered of Opioid Medication | Administration of opioid medication based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals With an Order for Antipsychotic Medication | Order for antipsychotic medication based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals Administered Antipsychotic Medication | Administration of antipsychotic medication based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals With an Order for Benzodiazepine Medication | Order for benzodiazepine medication based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals Who Received Benzodiazepine Medication | Administration of benzodiazepine medication based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals Who Received Scopolamine | Administration of scopolamine (for death rattle) based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Sublingual Administration | Sublingual administration of medication based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals With Pastoral Care Visit | Pastoral Care Visit based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals With an Advance Directive | Presence of advance directive based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| Secondary | Individuals With a Palliative Care Consultation | Palliative Care Consultation based on abstraction of medical record | Posted | Number | participants | Pre and Post Intervention |
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| 0 |
| 0 |
| 0 |
| 0 |
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| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D012818 | Signs and Symptoms, Respiratory |