加强提前护理计划和生活回顾纵向干预（EARLI）：生活故事工作的集群随机对照交叉试验方案，促进了澳大利亚老年人在社区环境中的提前护理计划。

IF 2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Contemporary clinical trials Pub Date : 2025-02-01 DOI:10.1016/j.cct.2024.107795

Ava Karusoo-Musumeci , Ling Yeoh , Rebecca Walton , Tiet-Hanh Dao-Tran , Elizabeth Halcomb , Kirsten A. Auret , Josephine M. Clayton , Susan Kurrle , Elissa Campbell , Michelle Hilgeman , Ron Sinclair , Anne Meller , Simon Towler , Caroline E. Edwards , Tracy Comans , Craig Sinclair

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引用次数: 0

摘要

背景：预先护理计划（ACP）对老年人有潜在的帮助，然而，社区老年护理机构的采用率很低。先前的试点研究表明，整体的、以人为中心的ACP方法可能对经历功能障碍但不一定有明确预后的生命限制条件的老年人有效。本文描述了一项随机试验的方案，以测试组合生活故事工作的有效性，并促进ACP在促进接受社区老年护理服务的老年人参与ACP方面的作用。方法：增强提前护理计划和生活回顾纵向干预（EARLI）试验是一项开放标签、交叉、聚类随机对照试验，在新南威尔士州和西澳大利亚州有12家老年护理机构参与。参与者年龄在65岁 或以上，接受家庭护理服务，并能够在最初招募时提供知情同意。招募在两年的时间内进行，研究地点随机分配，在第一年或第二年接受四次干预（或单次“积极控制”条件）。主要结果是参与者报告的ACP参与情况和老年护理客户记录中的ACP文件，招募后12 周。次要结果包括决策冲突、焦虑和抑郁、基于意义的应对和关系质量的测量。分析将采取意向治疗方法。结论：本试验测试了一种新颖的方法，通过整体的、以人为本的方法来促进老年人的ACP参与。加强ACP的参与可以减少决策冲突，最大限度地减少住院率，并改善患者及其家庭的结果。ANZCTR试验注册号：ACTRN12622001399785。

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Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI): Protocol for a cluster randomized controlled cross-over trial of life story work and facilitated advance care planning among older Australian adults in community settings

Background

Advance care planning (ACP) is potentially helpful for older adults, however, the rate of uptake in community aged care settings is low. Previous pilot studies suggest that holistic, person-centered ACP approaches may be effective for older adults who experience functional impairment but do not necessarily have life-limiting conditions with clear prognoses. This paper describes the protocol of a randomized trial to test the effectiveness of combined life story work and facilitated ACP in promoting ACP engagement among older adults receiving community aged care services.

Methods

The Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI) trial is an open-label, cross-over, cluster randomized controlled trial with 12 participating aged care organizations in New South Wales and Western Australia. Participants are aged 65 years or older, receiving home care services and capable of providing informed consent at initial recruitment. Recruitment occurs across a two-year period, with study sites randomized to receive the four-session intervention in the first or second year (or a single session ‘active control’ condition). Primary outcomes are participant-reported ACP engagement and ACP documentation in the aged care client record 12 weeks post-recruitment. Secondary outcomes include measures of decisional conflict, anxiety and depression, meaning-based coping and relationship quality. Analysis will take an intention-to-treat approach.

Conclusion

This trial tests a novel method of reaching older adults using a holistic, person-centered approach to promoting ACP engagement. Enhancing ACP engagement may reduce decisional conflict, minimize hospital admissions and improve outcomes for people and their families.

ANZCTR Trial Registration ID: ACTRN12622001399785.

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来源期刊

Contemporary clinical trials 医学-药学

CiteScore

3.70

自引率

4.50%

发文量

281

审稿时长

44 days

期刊介绍： Contemporary Clinical Trials is an international peer reviewed journal that publishes manuscripts pertaining to all aspects of clinical trials, including, but not limited to, design, conduct, analysis, regulation and ethics. Manuscripts submitted should appeal to a readership drawn from disciplines including medicine, biostatistics, epidemiology, computer science, management science, behavioural science, pharmaceutical science, and bioethics. Full-length papers and short communications not exceeding 1,500 words, as well as systemic reviews of clinical trials and methodologies will be published. Perspectives/commentaries on current issues and the impact of clinical trials on the practice of medicine and health policy are also welcome.