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Efficacy of a Decision Aid Consisting of a Video and Booklet on Advance Care Planning for Advanced Cancer Patients: Randomized Controlled Trial

Title
Efficacy of a Decision Aid Consisting of a Video and Booklet on Advance Care Planning for Advanced Cancer Patients: Randomized Controlled Trial
Authors
Yun, Young HoKang, EunKyoPark, SoheeKoh, Su-JinOh, Ho-SukKeam, BhumsukRok, YoungChang, Won JinJeong, Hyun SikNam, Eun MiJung, Kyung HaeKim, Hak RoChoo, JiyeonLee, JihyeSim, Jin-Ah
Ewha Authors
남은미
SCOPUS Author ID
남은미scopusscopus
Issue Date
2019
Journal Title
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN
0885-3924JCR Link

1873-6513JCR Link
Citation
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT vol. 58, no. 6, pp. 940 - +
Keywords
Advance care planningdecision aidadvanced cancer patients
Publisher
ELSEVIER SCIENCE INC
Indexed
SCIE; SCOPUS WOS scopus
Document Type
Article
Abstract
Context. Few randomized controlled trials of advance care planning (ACP) with a decision aid (DA) show an effect on patient preferences for end-of-life (EOL) care over time, especially in racial/ethnic settings outside the U.S. Objectives. The objective of this study was to examine the effect of a decision aid consisting of a video and an ACP booklet for EOL care preferences among patients with advanced cancer. Methods. Using a computer-generated sequence, we randomly assigned (1:1) patients with advanced cancer to a group that received a video and workbook that both discussed either ACP (intervention group) or cancer pain control (control group). At baseline, immediately after intervention, and at 7 weeks, we evaluated the subjects' preferences. The primary outcome was preference for EOL care (active treatment, life-prolonging treatment, or hospice care) on the assumption of a fatal disease diagnosis and the expectation of death 1) within 1 year, 2) within several months, and 3) within a few weeks. We used Bonferroni correction methods for multiple comparisons with an adjusted P level of 0.005. Results. From August 2017 to February 2018, we screened 287 eligible patients, of whom 204 were enrolled to the intervention (104 patients) or the control (100 patients). At postintervention, the intervention group showed a significant increase in preference for active treatment, life-prolonging treatment, and hospice care on the assumption of a fatal disease diagnosis and the expectation of death within 1 year (P < 0.005). Assuming a life expectancy of several months, the change in preferences was significant for active treatment and hospice care (P < 0.005) but not for life-prolonging treatment. The intervention group showed a significant increase in preference for active treatment, life-prolonging treatment, and hospice care on the assumption of a fatal disease diagnosis and the expectation of death within a few weeks (P < 0.005). From baseline to 7 weeks, the decrease in preference in the intervention group was not significant for active treatment, life-prolonging treatment, and hospice care in the intervention group in the subset expecting to die within 1 year, compared with the control group. Assuming a life expectancy of several months and a few weeks, the change in preferences was not significant for active treatment and for life-prolonging treatment but was significantly greater for hospice care in the intervention group (P < 0.005). Conclusion. ACP interventions that included a video and an accompanying book improved preferences for EOL care. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
DOI
10.1016/j.jpainsymman.2019.07.032
Appears in Collections:
의과대학 > 의학과 > Journal papers
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