Advance care planning procedure in older patients at a high risk of death after discharge from the acute geriatric unit: A study protocol

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics Pub Date : 2025-03-24 DOI:10.1016/j.archger.2025.105836

Fabien Visade , Guillaume Deschasse , Frédéric Roca , Cédric Villain , Sylvia Pelayo , Romaric Marcilly , Matthieu Calafiore , Paul Quindroit , Chloé Prod'homme , Clémence Levesque , Williams Vandenberghe , Laurène Norberciak , Marie Buttitta , Carla Di Martino , Jean-Baptiste Beuscart

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引用次数: 0

Abstract

The SAPHARI (“Home-based Nurse Intervention in the Care of High-Risk-of-Death Patients after Discharge from a Geriatric Department”) prospective, multicenter, randomized, controlled, open-label study has been designed to evaluate the effectiveness of implementing advance care planning (ACP) in older patients at a high risk of death. Patients aged 75 or over, at a high risk of death (according to the DAMAGE prognostic score) and discharged alive to home or to a nursing home from an acute geriatric unit will be included and followed up for 12 months. We plan to randomize 104 patients into a control group or an intervention group. The patients in the intervention group will receive an in-home intervention by an expert advanced practice nurse trained in the implementation of ACP. The primary outcome will focus on the intervention's feasibility: the proportion of patients included and randomized, the proportion completing in the study, and the proportion having engaged in ACP within a month of discharge. A secondary efficacy outcome will be compliance with advance directives (drafted at the time of ACP) at 12 months in each of the two study groups. Symptom's of anxiety and depression, the intervention's acceptability, and changes in quality of life will be documented in patients, family carers, and professional caregivers. The patients' and caregivers' experience of the intervention will be explored in qualitative analyses. Lastly, the intervention's implementation will be analyzed, with a view to understanding the results and identifying factors that will foster generalization of the conclusions. Through this project, we hope to lay the foundations for better care of very frail older patients at the end of life. The results of our study will provide robust, scientific evidence to fuel the long-standing but evolving social and political debate over the right to a dignified end of life.

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来源期刊

Archives of gerontology and geriatrics 医学-老年医学

CiteScore

7.30

自引率

5.00%

发文量

198

审稿时长

16 days

期刊介绍： Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published. Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.