Details
Study title
DemFACTS - Fact Boxes as Decision Support for Burdensome Medical Interventions in Dementia: A Randomized Controlled Trial
Ref study 12091
Study language English
Contributing institutions
Authors
Keywords
  • Treatment
  • Decision-making
  • Dementia
  • End-of-life
  • Advanced
  • Proxies
  • Burdensome
Disciplines
Period
3/2015 – 6/2018
Geographical space
Swiss-german part of Switzerland
Country
  • Switzerland
Abstract
Background: Antibiotics and artificial hydration use may be of limited benefits in advanced dementia.
Objectives: To test Fact Box Decision Supports on participants’ subjective outcomes about decisions on antibiotics and artificial hydration use in advanced dementia.
Design: The DEMentia FACT box study (DEMFACT) was a randomized controlled trial conducted between June 2016 and October 2016.
Conclusions: Fact Box Decision Supports improve the outcomes of multiple stakeholders for hypothetical decisions on antibiotics and artificial hydration use in advanced dementia, and the Fact Box on antibiotics is associated with decisions against aggressive treatment.
Results
Results: Participants were on average 55.6 years old (range 26-87) and 62.5% were female. Fact Boxes recipients showed a greater reduction of their decisional conflict scores about decisions on antibiotics (unstandardized beta (b)=-8.35; 95% Confidence Interval (CI), -12.43, -4.28) and artificial hydration use (b=-6.02; 95% CI, -9.84, -2.20) when compared to non-recipients. They displayed greater knowledge about effects of antibiotics (b=2.24; 95% CI, 1.79, 2.68) and artificial hydration (b=3.01; 95% CI, 2.53, 3.49), and were more likely to make decisions against antibiotics (odds ratio, 2.29; 95% CI, 1.08, 4.84), but not against artificial hydration use (OR, 1.07; 95% CI, 0.49, 2.36). Twenty-nine out of 30 physicians, who received the Fact Boxes, would use them as communication tool.
Methods (description)
Design: The DEMentia FACT box study (DEMFACT) was a randomized controlled trial conducted between June 2016 and October 2016.
Setting: German-speaking part of Switzerland, at two time points participants received a 60-minute, paper-pencil questionnaire at home.
Subjects: 232 participants (intervention, N=114; control, N=118) composed of 64 physicians, 100 relatives of people with dementia, and 68 professional guardians.
Intervention: Fact Box Decision Supports about antibiotics and artificial hydration use in advanced dementia (versus no Fact Box) for decisions based on hypothetical scenarios.
Methods: The primary outcome was decisional conflict (DCS-D; range 0-100, higher scores indicate greater conflict) about antibiotics and artificial hydration decisions, assessed at baseline and one month later. Secondary outcomes, measured at both time points, included: knowledge about treatments effects (own scales; range 0-7, higher scores indicate greater knowledge), proportions of decisions against interventions use, and acceptability of Fact Boxes (only intervention group at one-month). Mixed effect models and regressions examined group differences and changes in repeated outcome measurements.
Methods (instruments)
  • Analysis of content - standardized
Publications
  • Loizeau, Andrea; Theill, Nathan; Cohen, S. M.; Eicher, Stefanie; Mitchell, S. L.; Meier, S.; McDowell, M.; Martin, Mike; Riese, Florian. Fact Box Decision Support Tools for Antibiotics for Pneumonia and Artificial Hydration in Advanced Dementia: a Randomized Controlled Trial. Age & Ageing, Under review since March 15, 2018.
Unpublished documents
  • Loizeau, Andrea; Eicher, Stefanie; Theill, Nathan; Martin, Mike; Riese, Florian. 2017. Medical Interventions and Palliative Care: What to Decide in Advanced Dementia?. Poster presented at the 21st World Congress of Gerontology and Geriatrics: Innovation in Aging by the International Association of Gerontology and Geriatrics (IAGG), July 23-27, San Fransisco, California, USA (pp. 369).
  • Loizeau, Andrea; Eicher, Stefanie; Theill, Nathan; Martin, Mike; Riese, Florian. 2016. DemFACTS - Fact Boxes as Decision Support for Burdensome Medical Interventions in Dementia: A Randomized Controlled Trial. Poster presented at the Swiss National Gerontology Congress: age@technic by the Swiss Society for Gerontology (SSG), January 28-29, Fribourg, Switzerland.
  • Loizeau, Andrea; Eicher, Stefanie; Theill, Nathan; Martin, Mike; Riese, Florian. 2016. DemFACTS - Antibiotics for Pneumonia and Artificial Hydration for Insufficient Fluid Intake in Advanced Dementia. Poster presented at the 12th Congress of the European Union Geriatric Medicine Society (EUGG): Discovering new ways in the World of Geriatrics, October 5-7, Lisbon, Portugal (pp. 110).
  • Loizeau, Andrea; Eicher, Stefanie; Theill, Nathan; Martin, Mike; Riese, Florian. 2016. DemFACTS - Medical Interventions and Palliative Care, What to Decide for my Loved one with Advanced Dementia?. Poster presented at the 26th Alzheimer Europe Conference: Excellence in dementia research and care, October 31-November 2, Copenhagen, Denmark.
  • Loizeau, Andrea; Eicher, Stefanie; Theill, Nathan; Martin, Mike; Riese, Florian. 2015. DemFACTS — Fact Boxes as Decision support for Burdensome medical Interventions in Dementia: A Randomized Controlled Trial. Poster presented at the National Palliative Care Days, December 2-3, Bern, Switzerland (pp. 25).
  • Loizeau, Andrea; Eicher, Stefanie; Theill, Nathan; Martin, Mike; Riese, Florian. 2015. DemFACTS - Facts. Boxes for Burdensome Medical Interventions in Palliative Care in Dementia. Poster presented at the 25th Alzheimer Europe Conference: Dementia, putting strategies and research into practice, September 2-4, Ljubljana, Slovenia.
  • Loizeau, Andrea; Cohen, S. M.; Mitchell, S. L.; Theill, Nathan; Eicher, Stefanie; Martin, Mike; Riese, Florian. Physician and Surrogate Agreement with Assisted Dying and Continuous Deep Sedation in Advanced Dementia in Switzerland. Targeted journal, J. Pain Symptom Manag.
  • Loizeau, Andrea; Eicher, Stefanie; Theill, Nathan; Martin, Mike; Riese, Florian. 2017. Efficacy of fact boxes for informing decision-making on burdensome medical interventions in advanced dementia. Oral presentation at the 10th World Research Congress of the European Association for Palliative Care (EAPC), May 23-26, Bern, Switzerland.
Financed by
  • Other: Swiss Academy of Medical Sciences, Stanley Thomas Johnson Foundation, Gottfried and Julia Bangerter-Rhyner-Foundation
  • Other: Doc.Mobility Grant by the Swiss National Science Foundation for research stay at Harvard Medical School (01/02/2017-31/12/2017)
Study type
Data availability
Source (Updates) Web
Date created 05.06.2018
Date modified 13.06.2018
Start - End date 02.03.2015 - 30.06.2018