The Promoting Effective Advance Care for Elders (PEACE) Randomized Pilot Study: Theoretical Framework and Study Design

Abstract

Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study. PEACE is an ongoing 2-group randomized pilot study (n=80) to test an in-home interdisciplinary care management intervention that combines palliative care approaches to symptom management, psychosocial and emotional support, and advance care planning with geriatric medicine approaches to optimizing function and addressing polypharmacy. The population comprises new enrollees into PASSPORT, Ohio's community-based, long-term care Medicaid waiver program. All PASSPORT enrollees have geriatric/palliative care crossover needs because they are nursing home eligible. The intervention is based on Wagner's Chronic Care Model and includes comprehensive interdisciplinary care management for these low-income frail elders with chronic illnesses, uses evidence-based protocols, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. Our model, with its standardized, evidence-based medical and psychosocial intervention protocols, will transport easily to other sites that are interested in optimizing outcomes for community-based, chronically ill older adults.

Managing in the Trenches of Consumer Care: The Challenges of Understanding and Initiating the Advance Care Planning Process

“…We informed each AAA in Ohio, except one agency already participating in the PEACE trial (Allen et al, 2011), about our qualitative study and organized focus group meetings. To recruit a convenience sample, an e-mail from our research team requesting participation was sent to care managers who spent at least 50% of their time with consumers.…”

“…There has been little research on advance care planning conducted in the community with nonphysician facilitators. Some exceptions include the Respecting Choices program (Hammes et al, 2010), a study by Ratner, Norlander and McSteen (2001), and the Promoting Effective Advance Care for Elders (PEACE) trial (Allen et al, 2011). In the Respecting Choices program, nonphysician community volunteers were trained to facilitate advance care planning discussions within the patient's home.…”

“…The PEACE trial was a randomized pilot study that targeted individuals who were transitioning into Ohio's Medicaid waiver program, PASSPORT (Allen et al, 2011). The PEACE intervention used Area Agency on Aging (AAA) care managers with input from an interdisciplinary team to initiate advance care planning discussions in the consumer's home upstream in the chronic illness trajectory (i.e., closer to the time of diagnosis).…”

Care models for people with chronic diseases: integrative review

“…The promoting effective advance care for elders (PEACE) randomized pilot study: theoretical framework and study design 17 Allen et al…”

Realist Review to Inform Development of the Electronic Advance Care Plan for the Personally Controlled Electronic Health Record in Australia

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