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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Palliative Care 1/2015

A mixed method feasibility study of a patient- and family-centred advance care planning intervention for cancer patients

Zeitschrift:
BMC Palliative Care > Ausgabe 1/2015
Autoren:
Natasha Michael, Clare O’Callaghan, Angela Baird, Karla Gough, Mei Krishnasamy, Nathaniel Hiscock, Josephine Clayton
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12904-015-0023-1) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare no conflict of interest. NM and COC have full control of the data and will allow review of data if requested.

Authors’ contributions

NM conceived of the study, managed the research, was a qualitative data inter-rater and the lead author of the manuscript. CO provided input into study design, conducted qualitative research interviews, led qualitative data analysis, and helped to draft the manuscript. AB provided input into study design, conducted the research intervention, performed data entry, and helped to draft the manuscript. KG provided input into study design, conducted statistical analysis, and helped to draft the manuscript. MK provided input into study design and helped to draft the manuscript. NH performed data entry and prepared the manuscript for publication. JC provided input into study design and helped to draft the manuscript. All authors read and approved the final manuscript.

Abstract

Background

Advance care planning (ACP) is a process whereby values and goals are sensitively explored and documented to uphold patients’ wishes should they become incompetent to make decisions in the future. Evidenced-based, effective approaches are needed. This study sought to assess the feasibility and acceptability of an ACP intervention informed by phase 1 findings and assessed the suitability of measures for a phase 3 trial.

Methods

Prospective, longitudinal, mixed methods study with convenience sampling. A skilled facilitator conducted an ACP intervention with stage III/IV cancer patients and invited caregivers. It incorporated the vignette technique and optional completion/integration of ACP documents into electronic medical records (EMR). Quantitative and qualitative data were collected concurrently, analysed separately, and the two sets of findings converged.

Results

Forty-seven percent consent rate with 30 patients and 26 caregivers completing the intervention. Ninety percent of patient participants had not or probably not written future care plans. Compliance with assessments was high and missing responses to items low. Small- to medium-sized changes were observed on a number of patients and caregiver completed measures, but confidence intervals were typically wide and most included zero. An increase in distress was reported; however, all believed the intervention should be made available. Eleven documents from nine patients were incorporated into EMR. ACP may not be furthered because of intervention inadequacies, busy lives, and reluctance to plan ahead.

Conclusions

In this phase 2 study we demonstrated feasibility of recruitment and acceptability of the ACP intervention and most outcome measures. However, patient/family preferences about when and whether to document ACP components need to be respected. Thus flexibility to accommodate variability in intervention delivery, tailored to individual patient/family preferences, may be required for phase 3 research.
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