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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急性老年病房出院后死亡风险高的老年患者的预先护理计划程序：一项研究方案

前瞻性、多中心、随机、对照、开放标签的SAPHARI（“以家庭为基础的护士干预护理老年科出院后死亡风险高的患者”）研究旨在评估在死亡风险高的老年患者中实施预先护理计划（ACP）的有效性。75岁或以上、死亡风险高（根据损害预后评分）、从急性老年病房活着出院回家或到养老院的患者将被纳入研究，随访12个月。我们计划将104例患者随机分为对照组和干预组。干预组的患者将由经过ACP实施培训的高级执业护士进行家庭干预。主要结局将关注干预的可行性：纳入和随机患者的比例，完成研究的比例，出院后一个月内进行ACP的比例。次要疗效结果将是两个研究组在12个月时对预先指示（在ACP时起草）的依从性。患者、家庭护理人员和专业护理人员的焦虑和抑郁症状、干预的可接受性和生活质量的变化将被记录下来。患者和护理人员对干预的体验将在定性分析中进行探讨。最后，将分析干预措施的实施情况，以期了解结果并确定有助于结论普遍化的因素。通过这个项目，我们希望为在生命的尽头更好地照顾非常虚弱的老年患者奠定基础。我们的研究结果将提供有力的科学证据，为长期存在但不断演变的关于有尊严地结束生命的权利的社会和政治辩论提供动力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.