The online version of this article (doi:10.1186/s12904-015-0023-1) contains supplementary material, which is available to authorized users.
The authors declare no conflict of interest. NM and COC have full control of the data and will allow review of data if requested.
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.
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.
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.
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.
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.
Additional file 1: ACP intervention.12904_2015_23_MOESM1_ESM.pdf
Canadian Hospice Palliative Care Association: Advance care planning in Canada: A national framework and implementation. National roundtable proceedings. [ http://www.chpca.net/media/7443/acp_national_roundtable_meeting_proceedings_may_09.pdf/ webcite].
Wendtlandt K, Burman D, Swami N, Hales S, Rydall A, Rodin G, et al. Preparation for the end of life in patients with advanced cancer and association with communication with professional caregivers. Psychooncology. 2012;21(8):868–76. CrossRef
Advance Care Planning Australia: (2015). [ http://advancecareplanning.org.au/ webcite].
A national framework for advance care directives. [ http://www.health.wa.gov.au/advancecareplanning/docs/AdvanceCareDirectives2011.pdf].
Tulsky JA. Beyond advance directives: importance of communication skills at the end of life. J Am Med Assoc. 2005;294(3):359–65. CrossRef
O'Connor A, Stacey D, Entwistle V, Llewell-Thomas H, Rovner D, Holmes-Rovner M, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2003;(2):CD001431. Review. Update in: Cochrane Database Syst Rev 2009;(3):CD001431.25.
Thabane L, Ma J, Chu R, Cheng J, Asmaila A, Rios LP, et al. A tutorial on pilot studies: the what, why and how. BMC Medical Res Methodol. 2010;10:1. CrossRef
Gundersen HealthSystem: Respecting Patient Choices; 2015. [ http://www.gundersenhealth.org/respecting-choices/ webcite].
CHPCA: Speak up: start the conversation about end-of-life care. Canadian Hospice Palliative Care Association Inc; 2015. [ www.advancecareplanning.ca/ webcite].
Morse JM. Simultaneous and sequential qualitative mixed method designs. Qual Inq. 2010;16(11):483–91. CrossRef
Finch J. The vignette technique in survey research. Sociology. 1987;21(1):105–14. CrossRef
Hughes R. Considering the vignette technique and its application to a study of drug injecting and HIV risk and safer behaviour. Sociol Health Ill. 1998;20(3):381–400. CrossRef
Creswell JW, Plano Clark VL. Designing and conducting mixed methods research, 2e. Los Angeles: SAGE Publications; 2011.
IBM. SPSS Statistics for Windows VA. NY: IBM Corp; 2012.
3EQ-5D-3 L: Euroqual-5D-3L. [ http://www.euroqol.org/eq-5d-products/how-to-obtaineq-5d.html/ webcite].
O'Connor AM. User Manual - Decison Conflict Scale. [ http://decisionaid.ohri.ca/docs/develop/User_Manuals/UM_Decisional_Conflict.pdf/ webcite].
Fairclough DL. Design and analysis of quality of life studies in clinical trials 2e. Chapman & Hall/CRC: Boca Raton, FL; 2010.
Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
Corbin JM, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory, 3e. Thousand Oaks, CA: Sage Publications; 2008. CrossRef
ATLAS.ti 7. Scientific Software Development. Berlin: ATLAS.ti; 2013.
Kitto SC, Chesters J, Grbich C. Quality in qualitative research. Med J Aust. 2008;188(4):243–6. PubMed
Lyon ME. Advance care planning survey - Patient version. [ http://dch360.com/file/b33fd43/ webcite].
Department of Health, State Government of Victoria. Advance Care Planning. [ http://www.health.vic.gov.au/acp/ webcite].
National Health and Medical Research Council. An ethical framework for integrating palliative care principles into the management of advanced chronic or terminal conditions. [ http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/rec31_ethical_framework_palliative_care_terminal_110908.pdf/] webcite.
Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9. PubMed
- A mixed method feasibility study of a patient- and family-centred advance care planning intervention for cancer patients
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II