Document Type
Journal Article
Publisher
BMJ Group
School
School of Nursing and Midwifery
RAS ID
23544
Funders
WA Health Department State Health Research Advisory Committee RA/1/467/104
Abstract
Objective
Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed whether a systematic nurse-led ACP intervention increases ACP in patients with advanced respiratory disease.
Design
A multicentre open-label randomised controlled trial with preference arm.
Setting
Metropolitan teaching hospital and a rural healthcare network.
Participants
149 participants with respiratory malignancy, chronic obstructive pulmonary disease or interstitial lung disease.
Intervention
Nurse facilitators offered facilitated ACP discussions, prompted further discussions with doctors and loved ones, and assisted participants to appoint a substitute medical decision-maker (SDM) and complete an advance directive (AD).
Outcome measures
The primary measure was formal (AD or SDM) or informal (discussion with doctor) ACP uptake assessed by self-report (6 months) and medical notes audit. Secondary measures were the factors predicting baseline readiness to undertake ACP, and factors predicting postintervention ACP uptake in the intervention arm.
Results
At 6 months, formal ACP uptake was significantly higher (p < 0.001) in the intervention arm (54/106, 51 %), compared with usual care (6/43, 14 %). ACP discussions with doctors were also significantly higher (p < 0.005) in the intervention arm (76/106, 72 %) compared with usual care (20/43, 47 %). Those with a strong preference for the intervention were more likely to complete formal ACP documents than those randomly allocated. Increased symptom burden and preference for the intervention predicted later ACP uptake. Social support was positively associated with ACP discussion with loved ones, but negatively associated with discussion with doctors.
Conclusions
Nurse-led facilitated ACP is acceptable to patients with advanced respiratory disease and effective in increasing ACP discussions and completion of formal documents. Awareness of symptom burden, readiness to engage in ACP and relevant psychosocial factors may facilitate effective tailoring of ACP interventions and achieve greater uptake.
Trial registration number
ACTRN12614000255684
DOI
10.1136/bmjopen-2016-013415
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
Comments
Sinclair, C., Auret, K. A., Evans, S. F., Williamson, F., Dormer, S., Wilkinson, A., ... & Brims, F. (2017). Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advance care planning intervention. BMJ open, 7(2), Article e013415.
http://dx.doi.org/10.1136/bmjopen-2016-013415