Project to Improve Communication About Serious Illness - Pilot Study

Using the Electronic Health Record to Identify and Promote Goals-of-Care Communication

This two-year pilot study will test whether a one-page "Jumpstart Form" will affect goals-of-care discussions in the hospital. This form will be provided to clinicians and will include patient-specific information about preferences for goals-of-care communication and for care, as well as tips to improve this communication. Jumpstart forms will also be provided to patients or, if they are unable to communicate, their surrogates/family members. The information on the form will be obtained from questionnaires. The form is tailored to help patients and surrogates talk with clinicians about goals of care. This study is based on a successful application of Jumpstart Form in the outpatient clinic setting.

Inclusion Criteria, Patients: meeting criteria for serious illness (encompassing multiple acute and chronic illnesses) including:

• those used by the Dartmouth Atlas to study end-of-life care in the US: malignant cancer/leukemia, chronic pulmonary disease, coronary artery disease, congestive heart failure, chronic liver disease, chronic renal disease, dementia, diabetes with end-organ damage, and peripheral vascular disease.
• patients over age 65 with markers of frailty: albumin level <3.0 within 48 hours of admission and weight loss of ≥10 pounds in the past year.
• hospitalized patients over age 80.
• English-speaking

Exclusion Criteria, Patients:

• unable to complete informed consent procedures and do not have a legal next of kin
• restricted information status (e.g. prisoners)
• pregnant

Inclusion Criteria, Surrogates:

• involved in the care of an eligible patient as the legal next-of-kin
• English-speaking

Exclusion Criteria, Surrogates:

• unable to complete informed consent procedures