TY - JOUR
T1 - A randomised controlled trial of an advance care planning intervention for patients with incurable cancer
AU - Johnson, Stephanie B.
AU - Butow, Phyllis N.
AU - Bell, Melanie L.
AU - Detering, Karen
AU - Clayton, Josephine M.
AU - Silvester, William
AU - Kiely, Belinda E.
AU - Clarke, Stephen
AU - Vaccaro, Lisa
AU - Stockler, Martin R.
AU - Beale, Phillip
AU - Fitzgerald, Natalie
AU - Tattersall, Martin H.N.
N1 - Funding Information:
Funding: This study was funded by The National Health and Medical Research Council (grant number APP 1050596) and is administered through the University of Sydney.
Publisher Copyright:
© 2018, Cancer Research UK.
PY - 2018/11/13
Y1 - 2018/11/13
N2 - Background: We modified and evaluated an advance care planning (ACP) intervention, which had been shown to improve compliance with patient’s end of life (EoL) wishes, in a different patient population. Methods: Patients with incurable cancer, and a Family Member (FM), were randomised one-to-one to usual care or usual care plus an ACP intervention, between April 2014 and January 2017. Oncologists and participants were non-blinded. ACP was based on the Respecting Patient Choices model, with an offer to provide individualised ranges for typical, best-case and worst-case scenarios for survival time. Seven facilitators (two oncology nurses, two nurses and three allied health professionals) delivered the intervention within 2 weeks of study enrolment. The primary outcome measure, assessed by interviewing the FM 3 months after patient death, was the FM perception that the patient’s wishes were discussed, and met. Results: Six hundred and sixty-five patients from seven Australian metropolitan oncology centres were referred for consideration by their oncologists, 444 (67%) met the study inclusion criteria and were approached by a study researcher. Two hundred and eight patients (47%) and their FM entered the trial as dyads. Fifty-three (46%) dyads in the ACP group and 63 (54%) dyads in the usual-care group had complete primary outcome data (p = 0.16). Seventy-nine patients and 53 FMs attended an ACP discussion. Mean length of discussion was 57 min. FMs from 23 (43%) dyads allocated to ACP and 21 (33%) dyads allocated usual care reported the patient’s EoL wishes were discussed and met (difference 10%, 95% CI: −2 to 8, p = 0.27). There were no differences in EoL care received, patient satisfaction with care; FM satisfaction with care or with death; or FM well being. Rates of palliative care referral were high in both groups (97% vs 96%). Conclusions: A formal ACP intervention did not increase the likelihood that EoL care was consistent with patients’ preferences.
AB - Background: We modified and evaluated an advance care planning (ACP) intervention, which had been shown to improve compliance with patient’s end of life (EoL) wishes, in a different patient population. Methods: Patients with incurable cancer, and a Family Member (FM), were randomised one-to-one to usual care or usual care plus an ACP intervention, between April 2014 and January 2017. Oncologists and participants were non-blinded. ACP was based on the Respecting Patient Choices model, with an offer to provide individualised ranges for typical, best-case and worst-case scenarios for survival time. Seven facilitators (two oncology nurses, two nurses and three allied health professionals) delivered the intervention within 2 weeks of study enrolment. The primary outcome measure, assessed by interviewing the FM 3 months after patient death, was the FM perception that the patient’s wishes were discussed, and met. Results: Six hundred and sixty-five patients from seven Australian metropolitan oncology centres were referred for consideration by their oncologists, 444 (67%) met the study inclusion criteria and were approached by a study researcher. Two hundred and eight patients (47%) and their FM entered the trial as dyads. Fifty-three (46%) dyads in the ACP group and 63 (54%) dyads in the usual-care group had complete primary outcome data (p = 0.16). Seventy-nine patients and 53 FMs attended an ACP discussion. Mean length of discussion was 57 min. FMs from 23 (43%) dyads allocated to ACP and 21 (33%) dyads allocated usual care reported the patient’s EoL wishes were discussed and met (difference 10%, 95% CI: −2 to 8, p = 0.27). There were no differences in EoL care received, patient satisfaction with care; FM satisfaction with care or with death; or FM well being. Rates of palliative care referral were high in both groups (97% vs 96%). Conclusions: A formal ACP intervention did not increase the likelihood that EoL care was consistent with patients’ preferences.
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U2 - 10.1038/s41416-018-0303-7
DO - 10.1038/s41416-018-0303-7
M3 - Article
C2 - 30369600
AN - SCOPUS:85055710841
SN - 0007-0920
VL - 119
SP - 1182
EP - 1190
JO - British journal of cancer
JF - British journal of cancer
IS - 10
ER -