Aim 1. To test the effect of the Goals of Care decision support intervention compared to an attention control on the quality of communication and decision-making, defined at 3 months follow-up as a) quality of communication; b) surrogate – health care provider concordance on goals of care; and c) surrogate report of treatment consistent with the resident’s wishes.
Aim 2. To test the effect of the intervention on quality of palliative care for residents with advanced dementia, defined at 6 months follow-up as a) number of palliative care domains addressed for the resident in the care plan; b) symptom management; and c) surrogate satisfaction with care for advanced dementia.
Aim 3. To test the effect of the intervention on quality of dying for residents with advanced dementia, measured after death as a) surrogate – health care provider concordance on goals of care, and b) resident comfort in dying.
This research provides the first empiric test of the goals of care framework for dementia. It extends decision support research to surrogates, who make most decisions for patients with serious and incurable illness. To permit dissemination, the intervention design is pragmatic and well integrated with nursing home interdisciplinary care.
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