<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03239639</url>
  </required_header>
  <id_info>
    <org_study_id>3714</org_study_id>
    <nct_id>NCT03239639</nct_id>
  </id_info>
  <brief_title>Randomized Control Trial of Advance Care Planning in Primary Care</brief_title>
  <official_title>A Randomized Control Trial of an Advance Care Planning Intervention to Engaged Substitute Decision-makers in Primary Care</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>McMaster University</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Canadian Institutes of Health Research (CIHR)</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Queen's University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>McMaster University</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Sometimes people with health conditions become ill suddenly and can no longer speak for&#xD;
      themselves and another person (such as a family member) will make health care decisions for&#xD;
      them. This means it is important to think about your wishes and tell others about them. This&#xD;
      is called advance care planning. When people have done advance care planning, if they become&#xD;
      very sick and cannot speak for themselves they are more likely to get the kind of health care&#xD;
      they want and it is easier for the people who make decisions for them. There are tools such&#xD;
      as brochures, questionnaires, and videos that can help people learn about these things. This&#xD;
      research is being to done to study whether using tools for advance care planning and goals of&#xD;
      care discussions will improve how patients and their substitute decision makers do advance&#xD;
      care planning. This study is a randomized trial. This means half of the people in this study&#xD;
      will meet with someone at their family practice to talk about advance care planning and&#xD;
      review some tools and half will get usual care (a Speak Up workbook). The study will 1)&#xD;
      evaluate if reviewing the tools, and having help to complete them, helps patients and their&#xD;
      substitute decision maker do advance care planning 2) if this intervention will encourage&#xD;
      patients to talk to their family doctor about these issues.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      In prospective and randomized trials, advance care planning (ACP) significantly improves&#xD;
      outcomes including increased likelihood that clinicians and families understand and comply&#xD;
      with a patient's wishes, reduces hospitalization at the end of life, results in less&#xD;
      intensive treatments at the end of life (according to patients' wishes) and increases use of&#xD;
      hospice services. Trials have not been done in primary care. In this project, we aim to&#xD;
      determine the efficacy of a care pathway designed to increase the quality and quantity of ACP&#xD;
      in patients and their substitute decision-makers in primary care. The study is a multi-site,&#xD;
      patient-based, unblinded, randomized trial conducted in family practices in Canada.&#xD;
      Participants will be patients who are determined by their physician to be able to benefit&#xD;
      from ACP, and the patient's substitute decision-maker. Participant pairs will be randomized&#xD;
      to immediate intervention (care pathway) or delayed (8-12 weeks). The intervention is guided&#xD;
      use of tools and decision aids to clarify values and preferences for treatments in the event&#xD;
      of serious illness or near end of life. The outcomes will be substitute decision-maker&#xD;
      engagement in ACP (including self-efficacy for enacting the role), patient engagement in ACP,&#xD;
      and decisional conflict.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">March 1, 2018</start_date>
  <completion_date type="Actual">December 31, 2019</completion_date>
  <primary_completion_date type="Actual">December 31, 2019</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <intervention_model_description>Participants are assigned in 1:1 ratio to intervention or wait list control group</intervention_model_description>
    <primary_purpose>Supportive Care</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Advance care planning engagement of substitute decision-maker</measure>
    <time_frame>8 to 12 weeks (6 weeks for patients from cancer centre)</time_frame>
    <description>A survey of the substitute decision-maker's engagement in advance care planning</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Advance care planning engagement of patient</measure>
    <time_frame>8 to 12 weeks (6 weeks for patients from cancer centre)</time_frame>
    <description>A survey of the patient's engagement in advance care planning</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Substitute decision-maker self-efficacy survey</measure>
    <time_frame>8 to 12 weeks (6 weeks for patients from cancer centre)</time_frame>
    <description>A survey of the substitute decision-maker's confidence to make future decisions</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Decisional conflict</measure>
    <time_frame>immediately after intervention</time_frame>
    <description>A modified short decisional conflict survey</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Satisfaction with intervention</measure>
    <time_frame>immediately after intervention</time_frame>
    <description>A satisfaction and endorsement survey on the process of the educational intervention</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">61</enrollment>
  <condition>Chronic Illness</condition>
  <arm_group>
    <arm_group_label>Advance care planning education session</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Delivery of an advance care planning education session at the family doctor's office</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Wait list control</arm_group_label>
    <arm_group_type>Sham Comparator</arm_group_type>
    <description>The intervention is not provided.</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Advance care planning education session</intervention_name>
    <description>Administration of values clarification tool, elicitation of preference for treatment options, if preference for resuscitation, shown an educational video about cardiopulmonary resuscitation, summary document of values and preferences created by a facilitator to share with doctor</description>
    <arm_group_label>Advance care planning education session</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Wait list control</intervention_name>
    <description>No intervention</description>
    <arm_group_label>Wait list control</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Patients being treated for serious illness in outpatient settings or;&#xD;
&#xD;
          -  Patients who could benefit from advance care planning self-assessed or assessed by&#xD;
             their physician&#xD;
&#xD;
          -  Patient able and willing to identify a substitute decision-maker who will participate&#xD;
             in the study&#xD;
&#xD;
          -  Patient cognitively able to participate&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Patient or their substitute decision-maker does not speak English&#xD;
&#xD;
          -  Patient unable to identify a substitute decision-maker who will consent to&#xD;
             participation&#xD;
&#xD;
          -  Patient does not consent to participation&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>65 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Michelle Howard, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>McMaster University</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Dundas Family Health Team</name>
      <address>
        <city>Dundas</city>
        <state>Ontario</state>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Michael West Doctor Office</name>
      <address>
        <city>Dundas</city>
        <state>Ontario</state>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Burlington Family Health Team</name>
      <address>
        <city>Hamilton</city>
        <state>Ontario</state>
        <zip>L7S 0A1</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>St. Joseph's Healthcare Hamilton</name>
      <address>
        <city>Hamilton</city>
        <state>Ontario</state>
        <zip>L8N 4A6</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>McMaster Family Health Team</name>
      <address>
        <city>Hamilton</city>
        <state>Ontario</state>
        <zip>L8P 1H6</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>McMaster University Medical Centre</name>
      <address>
        <city>Hamilton</city>
        <state>Ontario</state>
        <zip>L8S 4K1</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Juravinski Cancer Centre Pain and Symptom Management Team</name>
      <address>
        <city>Hamilton</city>
        <state>Ontario</state>
        <zip>L8V 5C2</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Canada</country>
  </location_countries>
  <link>
    <url>http://www.ncbi.nlm.nih.gov/pubmed/26948697</url>
    <description>Metzger M, Song M-K, Ward S, Chang PP-Y, Hanson LC, Lin F-C. A randomized controlled pilot trial to improve advance care planning for LVAD patients and their surrogates. Hear Lung J Acute Crit Care. 2016 May;45(3):186-92</description>
  </link>
  <link>
    <url>http://www.ncbi.nlm.nih.gov/pubmed/7748044</url>
    <description>Johnston SC, Pfeifer MP, McNutt R. The discussion about advance directives. Patient and physician opinions regarding when and how it should be conducted. End of Life Study Group. Arch Intern Med. 1995 May 22;155(10):1025-30</description>
  </link>
  <link>
    <url>http://www.ncbi.nlm.nih.gov/pubmed/23028000</url>
    <description>Rhee JJ, Zwar NA, Kemp LA. Advance care planning and interpersonal relationships: a two-way street. Fam Pract. 2013 Apr 1;30(2):219-26</description>
  </link>
  <results_reference>
    <citation>De Vleminck A, Houttekier D, Pardon K, Deschepper R, Van Audenhove C, Vander Stichele R, Deliens L. Barriers and facilitators for general practitioners to engage in advance care planning: a systematic review. Scand J Prim Health Care. 2013 Dec;31(4):215-26. doi: 10.3109/02813432.2013.854590.</citation>
    <PMID>24299046</PMID>
  </results_reference>
  <results_reference>
    <citation>Teixeira AA, Hanvey L, Tayler C, Barwich D, Baxter S, Heyland DK; Canadian Researchers at End of Life Network (CARENET). What do Canadians think of advanced care planning? Findings from an online opinion poll. BMJ Support Palliat Care. 2015 Mar;5(1):40-7. doi: 10.1136/bmjspcare-2013-000473. Epub 2013 Oct 4.</citation>
    <PMID>24644188</PMID>
  </results_reference>
  <results_reference>
    <citation>Howard M, Bernard C, Tan A, Slaven M, Klein D, Heyland DK. Advance care planning: Let's start sooner. Can Fam Physician. 2015 Aug;61(8):663-5. No abstract available.</citation>
    <PMID>26273075</PMID>
  </results_reference>
  <results_reference>
    <citation>Rhee JJ, Zwar NA, Kemp LA. Advance care planning and interpersonal relationships: a two-way street. Fam Pract. 2013 Apr;30(2):219-26. doi: 10.1093/fampra/cms063. Epub 2012 Oct 1.</citation>
    <PMID>23028000</PMID>
  </results_reference>
  <results_reference>
    <citation>Robinson C, Kolesar S, Boyko M, Berkowitz J, Calam B, Collins M. Awareness of do-not-resuscitate orders: what do patients know and want? Can Fam Physician. 2012 Apr;58(4):e229-33.</citation>
    <PMID>22611610</PMID>
  </results_reference>
  <results_reference>
    <citation>Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, Matlock DD, Rietjens JAC, Korfage IJ, Ritchie CS, Kutner JS, Teno JM, Thomas J, McMahan RD, Heyland DK. Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. J Pain Symptom Manage. 2017 May;53(5):821-832.e1. doi: 10.1016/j.jpainsymman.2016.12.331. Epub 2017 Jan 3.</citation>
    <PMID>28062339</PMID>
  </results_reference>
  <results_reference>
    <citation>Houben CHM, Spruit MA, Groenen MTJ, Wouters EFM, Janssen DJA. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014 Jul;15(7):477-489. doi: 10.1016/j.jamda.2014.01.008. Epub 2014 Mar 2.</citation>
    <PMID>24598477</PMID>
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    <citation>Teno JM, Fisher ES, Hamel MB, Coppola K, Dawson NV. Medical care inconsistent with patients' treatment goals: association with 1-year Medicare resource use and survival. J Am Geriatr Soc. 2002 Mar;50(3):496-500. doi: 10.1046/j.1532-5415.2002.50116.x.</citation>
    <PMID>11943046</PMID>
  </results_reference>
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    <citation>Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010 Mar 23;340:c1345. doi: 10.1136/bmj.c1345.</citation>
    <PMID>20332506</PMID>
  </results_reference>
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    <citation>Hammes BJ, Rooney BL. Death and end-of-life planning in one midwestern community. Arch Intern Med. 1998 Feb 23;158(4):383-90. doi: 10.1001/archinte.158.4.383.</citation>
    <PMID>9487236</PMID>
  </results_reference>
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    <citation>Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010 Apr 1;362(13):1211-8. doi: 10.1056/NEJMsa0907901.</citation>
    <PMID>20357283</PMID>
  </results_reference>
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    <citation>Raymont V, Bingley W, Buchanan A, David AS, Hayward P, Wessely S, Hotopf M. Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study. Lancet. 2004 Oct 16-22;364(9443):1421-7. doi: 10.1016/S0140-6736(04)17224-3.</citation>
    <PMID>15488217</PMID>
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    <citation>Fried TR, Redding CA, Robbins ML, O'Leary JR, Iannone L. Agreement between older persons and their surrogate decision-makers regarding participation in advance care planning. J Am Geriatr Soc. 2011 Jun;59(6):1105-9. doi: 10.1111/j.1532-5415.2011.03412.x. Epub 2011 Jun 7.</citation>
    <PMID>21649619</PMID>
  </results_reference>
  <results_reference>
    <citation>Heyland DK, Ilan R, Jiang X, You JJ, Dodek P. The prevalence of medical error related to end-of-life communication in Canadian hospitals: results of a multicentre observational study. BMJ Qual Saf. 2016 Sep;25(9):671-9. doi: 10.1136/bmjqs-2015-004567. Epub 2015 Nov 9.</citation>
    <PMID>26554026</PMID>
  </results_reference>
  <results_reference>
    <citation>You JJ, Dodek P, Lamontagne F, Downar J, Sinuff T, Jiang X, Day AG, Heyland DK; ACCEPT Study Team and the Canadian Researchers at the End of Life Network (CARENET). What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families. CMAJ. 2014 Dec 9;186(18):E679-87. doi: 10.1503/cmaj.140673. Epub 2014 Nov 3.</citation>
    <PMID>25367427</PMID>
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  <results_reference>
    <citation>Heyland DK, Barwich D, Pichora D, Dodek P, Lamontagne F, You JJ, Tayler C, Porterfield P, Sinuff T, Simon J; ACCEPT (Advance Care Planning Evaluation in Elderly Patients) Study Team; Canadian Researchers at the End of Life Network (CARENET). Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med. 2013 May 13;173(9):778-87. doi: 10.1001/jamainternmed.2013.180.</citation>
    <PMID>23545563</PMID>
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    <citation>Heyland DK, Lavery JV, Tranmer JE, Shortt SE, Taylor SJ. Dying in Canada: is it an institutionalized, technologically supported experience? J Palliat Care. 2000 Oct;16 Suppl:S10-6.</citation>
    <PMID>11075528</PMID>
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    <citation>Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA, Stapleton RD. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med. 2009 Jul 2;361(1):22-31. doi: 10.1056/NEJMoa0810245.</citation>
    <PMID>19571280</PMID>
  </results_reference>
  <verification_date>January 2019</verification_date>
  <study_first_submitted>August 2, 2017</study_first_submitted>
  <study_first_submitted_qc>August 2, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">August 4, 2017</study_first_posted>
  <last_update_submitted>February 19, 2020</last_update_submitted>
  <last_update_submitted_qc>February 19, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">February 20, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Substitute decision makers of patient</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Chronic Disease</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03239639
org study id: 3714
nct id: NCT03239639
lead sponsor: 
collaborator: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Sometimes people with health conditions become ill suddenly and can no longer speak for
      themselves and another person (such as a family member) will make health care decisions for
      them. This means it is important to think about your wishes and tell others about them. This
      is called advance care planning. When people have done advance care planning, if they become
      very sick and cannot speak for themselves they are more likely to get the kind of health care
      they want and it is easier for the people who make decisions for them. There are tools such
      as brochures, questionnaires, and videos that can help people learn about these things. This
      research is being to done to study whether using tools for advance care planning and goals of
      care discussions will improve how patients and their substitute decision makers do advance
      care planning. This study is a randomized trial. This means half of the people in this study
      will meet with someone at their family practice to talk about advance care planning and
      review some tools and half will get usual care (a Speak Up workbook). The study will 1)
      evaluate if reviewing the tools, and having help to complete them, helps patients and their
      substitute decision maker do advance care planning 2) if this intervention will encourage
      patients to talk to their family doctor about these issues.
In prospective and randomized trials, advance care planning (ACP) significantly improves
      outcomes including increased likelihood that clinicians and families understand and comply
      with a patient's wishes, reduces hospitalization at the end of life, results in less
      intensive treatments at the end of life (according to patients' wishes) and increases use of
      hospice services. Trials have not been done in primary care. In this project, we aim to
      determine the efficacy of a care pathway designed to increase the quality and quantity of ACP
      in patients and their substitute decision-makers in primary care. The study is a multi-site,
      patient-based, unblinded, randomized trial conducted in family practices in Canada.
      Participants will be patients who are determined by their physician to be able to benefit
      from ACP, and the patient's substitute decision-maker. Participant pairs will be randomized
      to immediate intervention (care pathway) or delayed (8-12 weeks). The intervention is guided
      use of tools and decision aids to clarify values and preferences for treatments in the event
      of serious illness or near end of life. The outcomes will be substitute decision-maker
      engagement in ACP (including self-efficacy for enacting the role), patient engagement in ACP,
      and decisional conflict.
allocation: Randomized
intervention model: Parallel Assignment
intervention model description: Participants are assigned in 1:1 ratio to intervention or wait list control group
primary purpose: Supportive Care
masking: None (Open Label)
measure: Advance care planning engagement of substitute decision-maker
time frame: 8 to 12 weeks (6 weeks for patients from cancer centre)
description: A survey of the substitute decision-maker's engagement in advance care planning
measure: Advance care planning engagement of patient
time frame: 8 to 12 weeks (6 weeks for patients from cancer centre)
description: A survey of the patient's engagement in advance care planning
measure: Substitute decision-maker self-efficacy survey
time frame: 8 to 12 weeks (6 weeks for patients from cancer centre)
description: A survey of the substitute decision-maker's confidence to make future decisions
measure: Decisional conflict
time frame: immediately after intervention
description: A modified short decisional conflict survey
measure: Satisfaction with intervention
time frame: immediately after intervention
description: A satisfaction and endorsement survey on the process of the educational intervention
arm group label: Advance care planning education session
arm group type: Experimental
description: Delivery of an advance care planning education session at the family doctor's office
arm group label: Wait list control
arm group type: Sham Comparator
description: The intervention is not provided.
intervention type: Behavioral
intervention name: Advance care planning education session
description: Administration of values clarification tool, elicitation of preference for treatment options, if preference for resuscitation, shown an educational video about cardiopulmonary resuscitation, summary document of values and preferences created by a facilitator to share with doctor
arm group label: Advance care planning education session
intervention type: Other
intervention name: Wait list control
description: No intervention
arm group label: Wait list control
criteria: 
gender: All
minimum age: 65 Years
maximum age: N/A
healthy volunteers: No
last name: Michelle Howard, PhD
role: Principal Investigator
affiliation: McMaster University
facility: 
facility: 
facility: 
facility: 
facility: 
facility: 
facility: 
country: Canada
url: http://www.ncbi.nlm.nih.gov/pubmed/26948697
description: Metzger M, Song M-K, Ward S, Chang PP-Y, Hanson LC, Lin F-C. A randomized controlled pilot trial to improve advance care planning for LVAD patients and their surrogates. Hear Lung J Acute Crit Care. 2016 May;45(3):186-92
url: http://www.ncbi.nlm.nih.gov/pubmed/7748044
description: Johnston SC, Pfeifer MP, McNutt R. The discussion about advance directives. Patient and physician opinions regarding when and how it should be conducted. End of Life Study Group. Arch Intern Med. 1995 May 22;155(10):1025-30
url: http://www.ncbi.nlm.nih.gov/pubmed/23028000
description: Rhee JJ, Zwar NA, Kemp LA. Advance care planning and interpersonal relationships: a two-way street. Fam Pract. 2013 Apr 1;30(2):219-26
citation: De Vleminck A, Houttekier D, Pardon K, Deschepper R, Van Audenhove C, Vander Stichele R, Deliens L. Barriers and facilitators for general practitioners to engage in advance care planning: a systematic review. Scand J Prim Health Care. 2013 Dec;31(4):215-26. doi: 10.3109/02813432.2013.854590.
PMID: 24299046
citation: Teixeira AA, Hanvey L, Tayler C, Barwich D, Baxter S, Heyland DK; Canadian Researchers at End of Life Network (CARENET). What do Canadians think of advanced care planning? Findings from an online opinion poll. BMJ Support Palliat Care. 2015 Mar;5(1):40-7. doi: 10.1136/bmjspcare-2013-000473. Epub 2013 Oct 4.
PMID: 24644188
citation: Howard M, Bernard C, Tan A, Slaven M, Klein D, Heyland DK. Advance care planning: Let's start sooner. Can Fam Physician. 2015 Aug;61(8):663-5. No abstract available.
PMID: 26273075
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responsible party type: Sponsor
mesh term: Chronic Disease
sharing ipd: No