Yael Schenker, Shane C Belin, Tianxiu Wang, Rebecca L Sudore, Bernard Hammes, Robert M Arnold, Roberta Flowers, Eric Chiu, Julian Hall, Yvette Dudley-Morrissey, Betty Ferrell, Megan Crowley-Matoka, Adam Brufsky, Edward Chu, Vikram Gorantla, Dhaval Mehta, Roby Thomas, Melissa Yee, Douglas White
{"title":"促进与患者指导的晚期癌症患者的提前护理计划：一项随机临床试验。","authors":"Yael Schenker, Shane C Belin, Tianxiu Wang, Rebecca L Sudore, Bernard Hammes, Robert M Arnold, Roberta Flowers, Eric Chiu, Julian Hall, Yvette Dudley-Morrissey, Betty Ferrell, Megan Crowley-Matoka, Adam Brufsky, Edward Chu, Vikram Gorantla, Dhaval Mehta, Roby Thomas, Melissa Yee, Douglas White","doi":"10.1200/OP-25-00046","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Guidelines recommend advance care planning (ACP) to improve patient-centered care near the end of life (EOL), but the optimal approach is unknown. This single-blind, patient-level, randomized comparative effectiveness trial compared two patient-facing ACP interventions that are widely used but differ in costs and complexity.</p><p><strong>Methods: </strong>Adult patients with advanced solid tumors and their caregivers were recruited from academic and community oncology clinics. Participants were randomly assigned to facilitated ACP using trained nurse facilitators versus patient-directed ACP using written and web-based tools. The primary outcome was patient-reported ACP engagement (assessed at baseline and 12 weeks using a 15-item validated survey; range, 0-5; higher scores indicate higher engagement). Secondary outcomes included advance directive completion and communication about EOL wishes.</p><p><strong>Results: </strong>A total of 400 patients enrolled (mean [SD] age, 67.9 [10.5] years; 192 women [48%]). At 12 weeks, patients in the facilitated versus patient-directed group reported higher ACP engagement (4.34 [0.78] <i>v</i> 4.08 [0.82]; adjusted mean difference, 0.25 [95% CI, 0.1 to 0.4]; <i>P</i> = .0014) and higher odds of completing an advance directive (74.8% <i>v</i> 60.6%; OR, 2.52 [95% CI, 1.27 to 5.0]; <i>P</i> = .008). There were no significant differences between the facilitated and patient-directed groups in the odds of having a conversation about EOL wishes with family or friends (88.9% <i>v</i> 88%; OR, 1.13 [95% CI, 0.5 to 2.6]; <i>P</i> = .76) or physicians (49.6% <i>v</i> 40.6%; OR, 1.53 [95% CI, 0.9 to 2.7]; <i>P</i> = .13), and all ACP behaviors increased significantly from baseline in both groups.</p><p><strong>Conclusion: </strong>Facilitated ACP resulted in greater increases in ACP engagement and advance directive completion than patient-directed written and web-based materials. Although some patients with advanced cancer may engage in self-directed ACP, some may need additional facilitator support.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500046"},"PeriodicalIF":4.7000,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Facilitated Versus Patient-Directed Advance Care Planning Among Patients With Advanced Cancer: A Randomized Clinical Trial.\",\"authors\":\"Yael Schenker, Shane C Belin, Tianxiu Wang, Rebecca L Sudore, Bernard Hammes, Robert M Arnold, Roberta Flowers, Eric Chiu, Julian Hall, Yvette Dudley-Morrissey, Betty Ferrell, Megan Crowley-Matoka, Adam Brufsky, Edward Chu, Vikram Gorantla, Dhaval Mehta, Roby Thomas, Melissa Yee, Douglas White\",\"doi\":\"10.1200/OP-25-00046\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Guidelines recommend advance care planning (ACP) to improve patient-centered care near the end of life (EOL), but the optimal approach is unknown. This single-blind, patient-level, randomized comparative effectiveness trial compared two patient-facing ACP interventions that are widely used but differ in costs and complexity.</p><p><strong>Methods: </strong>Adult patients with advanced solid tumors and their caregivers were recruited from academic and community oncology clinics. Participants were randomly assigned to facilitated ACP using trained nurse facilitators versus patient-directed ACP using written and web-based tools. The primary outcome was patient-reported ACP engagement (assessed at baseline and 12 weeks using a 15-item validated survey; range, 0-5; higher scores indicate higher engagement). Secondary outcomes included advance directive completion and communication about EOL wishes.</p><p><strong>Results: </strong>A total of 400 patients enrolled (mean [SD] age, 67.9 [10.5] years; 192 women [48%]). At 12 weeks, patients in the facilitated versus patient-directed group reported higher ACP engagement (4.34 [0.78] <i>v</i> 4.08 [0.82]; adjusted mean difference, 0.25 [95% CI, 0.1 to 0.4]; <i>P</i> = .0014) and higher odds of completing an advance directive (74.8% <i>v</i> 60.6%; OR, 2.52 [95% CI, 1.27 to 5.0]; <i>P</i> = .008). There were no significant differences between the facilitated and patient-directed groups in the odds of having a conversation about EOL wishes with family or friends (88.9% <i>v</i> 88%; OR, 1.13 [95% CI, 0.5 to 2.6]; <i>P</i> = .76) or physicians (49.6% <i>v</i> 40.6%; OR, 1.53 [95% CI, 0.9 to 2.7]; <i>P</i> = .13), and all ACP behaviors increased significantly from baseline in both groups.</p><p><strong>Conclusion: </strong>Facilitated ACP resulted in greater increases in ACP engagement and advance directive completion than patient-directed written and web-based materials. Although some patients with advanced cancer may engage in self-directed ACP, some may need additional facilitator support.</p>\",\"PeriodicalId\":14612,\"journal\":{\"name\":\"JCO oncology practice\",\"volume\":\" \",\"pages\":\"OP2500046\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2025-03-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JCO oncology practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1200/OP-25-00046\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JCO oncology practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1200/OP-25-00046","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Facilitated Versus Patient-Directed Advance Care Planning Among Patients With Advanced Cancer: A Randomized Clinical Trial.
Purpose: Guidelines recommend advance care planning (ACP) to improve patient-centered care near the end of life (EOL), but the optimal approach is unknown. This single-blind, patient-level, randomized comparative effectiveness trial compared two patient-facing ACP interventions that are widely used but differ in costs and complexity.
Methods: Adult patients with advanced solid tumors and their caregivers were recruited from academic and community oncology clinics. Participants were randomly assigned to facilitated ACP using trained nurse facilitators versus patient-directed ACP using written and web-based tools. The primary outcome was patient-reported ACP engagement (assessed at baseline and 12 weeks using a 15-item validated survey; range, 0-5; higher scores indicate higher engagement). Secondary outcomes included advance directive completion and communication about EOL wishes.
Results: A total of 400 patients enrolled (mean [SD] age, 67.9 [10.5] years; 192 women [48%]). At 12 weeks, patients in the facilitated versus patient-directed group reported higher ACP engagement (4.34 [0.78] v 4.08 [0.82]; adjusted mean difference, 0.25 [95% CI, 0.1 to 0.4]; P = .0014) and higher odds of completing an advance directive (74.8% v 60.6%; OR, 2.52 [95% CI, 1.27 to 5.0]; P = .008). There were no significant differences between the facilitated and patient-directed groups in the odds of having a conversation about EOL wishes with family or friends (88.9% v 88%; OR, 1.13 [95% CI, 0.5 to 2.6]; P = .76) or physicians (49.6% v 40.6%; OR, 1.53 [95% CI, 0.9 to 2.7]; P = .13), and all ACP behaviors increased significantly from baseline in both groups.
Conclusion: Facilitated ACP resulted in greater increases in ACP engagement and advance directive completion than patient-directed written and web-based materials. Although some patients with advanced cancer may engage in self-directed ACP, some may need additional facilitator support.
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