Introduction
Study objectives
Methods
Participants
Inclusion criteria (on approach): |
- Consultation at a group practice or ambulatory emergency department |
- Age ≥ 18 years old |
- Estimated time left in waiting room ≥ 30 min |
Exclusion criteria (at first contact): |
- Patient incapable of making decisions about care and therefore unable to write AD |
- Patient not showing any interest in the study |
- Patient with acute pain at the time of recruitment (to avoid imposing additional burdens on them) |
- Patient uncomfortable with using a mobile phone or tablet and without a next of kin who could provide regular help |
- Lack of fluency in written and oral French (the app is only available in French) |
Study intervention
Setting, recruitment and randomization
Statistical plan
At recruitment (n = 473) | Post-intervention (n = 312) | |||
---|---|---|---|---|
Control | Treatment | Control | Treatment | |
n = 248 | n = 225 | n = 176 | n = 136 | |
Age, mean (median) | 45.3 (42.5) | 43 (44) | 46.4 (45.5) | 44.7 (47) |
Gender, n (%) | ||||
- Female | 131 (52.8) | 118 (52.4) | 94 (53.4) | 65 (47.8) |
- Male | 117 (47.2) | 106 (47.1) | 82 (46.6) | 70 (51.5) |
- Other | 0 | 1 (0.4) | 0 | 1 (0.7) |
Education (highest level achieved), n (%) | ||||
- Elementary school | 57 (23) | 41 (18.2) | 39 (22.2) | 27 (19.9) |
- High or professional school | 93 (37.5) | 97 (43.1) | 60 (34.1) | 53 (39) |
- University level | 98 (39.5) | 87 (38.7) | 77 (43.8) | 56 (41.2) |
Recruitment location, n (%) | ||||
- Emergency waiting room | 219 (88.3) | 205 (91.1) | 154 (87.5) | 123 (90.4) |
- Primary care waiting room | 27 (10.9) | 19 (8.4) | 20 (11.4) | 13 (9.6) |
- NA | 2 (0.8) | 1 (0.4) | 2 (1.1) | 0 |
Medication (nb of daily drugs taken), n (%) | ||||
- 0 drugs | 120 (48.3) | 109 (48.4) | 89 (50.6) | 65 (47.8) |
- 1–2 drugs | 71 (28.6) | 78 (34.7) | 50 (28.4) | 52 (38.2) |
- 3–4 drugs | 34 (13.7) | 27 (12) | 19 (10.8) | 13 (9.6) |
- 5–9 drugs | 17 (6.85) | 9 (4) | 13 (7.4) | 6 (4.4) |
- 10 and more | 6 (2.4) | 2 (0.8) | 5 (2.8) | 0 |
Medical consultations (nb of medical consultations in a year), mean (median) | 4.99 (2) | 3.97 (2) | 4.98 (2) | 3.78 (2) |
Results
Participant flow
Outcomes
Written AD at recruitment stage
Correlation tests and selection of explanatory variables
Interest in the ACP supporting tools (app versus HUG information leaflet)
Effectiveness of the ACP supporting tools
Contemplation (of an ACP event) | Between group difference (logistic regression): p = .048 | ||
Question asked of all participants: | |||
At recruitment: “Before today, have you ever thought about the possibility of having an accident or a serious illness that would cause you to lose your capacity for judgment? What kind of situation [accident, serious illness] did you think of?” | |||
Post-intervention: “Since the last time we met, have you thought about the possibility of having an accident or a serious illness that would cause you to lose your capacity for judgment? What kind of situation [accident, serious illness] did you think of?” | |||
Responses | Treatment | Control | Total Data |
Participants who, at the time of recruitment, reported having contemplated an ACP event | 61% (n = 83/136) | 63% (n = 111/176) | 62% (n = 194/312) |
Participants who reported having contemplated an ACP event during the 3–4 weeks after inclusion | 60% (n = 81/136) | 49% (n = 87/176) | 54% (n = 168/312) |
Decision (about contemplated event) | Between group difference (logistic regression): p > .05 | ||
Question asked of participants who reported having contemplated an ACP event in the previous question: | |||
At recruitment & Post-intervention: “Do you have any idea and can you tell me how you would like to be cared for in such situations?” < referring to the situations described by the patient in the previous question > | |||
Responses | Treatment | Control | Total Data |
At recruitment: participants who were able to express a decision about how they would like to be treated related to the ACP event(s) considered in the previous question | 46% (n = 63/136) | 40% (n = 70/176) | 43% (n = 133/312) |
Post-intervention: participants who have expressed (either in the first or in the second questionnaire) a decision about how they would like to be treated related to the ACP event(s) | 55% (n = 75/136) | 48% (n = 84/176) | 51% (n = 159/312) |
Pre-post increase in participants’ expressed decision about how they would like to be treated related to the ACP event | 9% (n = 12/136) | 8% (n = 14/176) | 8% (n = 26/312) |
Discussion (about decision) | Between group difference (logistic regression): p = .047 | ||
Question asked of participants who reported having taken a decision about an ACP event in the previous question: | |||
At recruitment & Post-intervention: “Have you talked about your life decisions or priorities < referring to the previously discussed event > with someone close to you? And with your professional caregivers?” | |||
Responses | Treatment | Control | Total Data |
At recruitment: participants who reported having discussed their decision related to the ACP event(s) considered in the previous question with relatives or HCP | 35% (n = 48/135*) | 30% (n = 53/175) | 32% (n = 101/311) |
Post-intervention: participants who reported having discussed (either in the first or in the second questionnaire) their decision related to the ACP event(s) considered in the previous question with relatives or HCP | 49% (n = 67/136) | 39% (n = 68/175) | 43% (n = 135/312) |
Pre-post increase of participants’ reported discussion about how they would like to be treated related to the ACP event | 14% (n = 19/135*) | 9% (n = 15/175) | 11% (n = 34/311) |
Writing (of AD) | Between group difference (logistic regression): p = .030 | ||
Question asked of all participants: | |||
At recruitment & Post-intervention: “Have you already written your Advance Directives?” | |||
Responses | Treatment | Control | Total Data |
At recruitment: participants who reported having written their AD | 2% (n = 3/136) | 7% (n = 12/176) | 5% (n = 15/312) |
Post-intervention: participants who reported having written their AD | 7% (n = 9/136) | 6% (n = 10/176) | 6% (n = 19/312) |
Pre-post increase in reported written AD | 4% (n = 6/136) | -1% (n = -2/176) | 1% (n = 4/312) |
At recruitment: participants who reported having started to write their AD but not yet finished | 0% (n = 0/136) | 0% (n = 0/176) | 0% (n = 0/312) |
Post-intervention: participants who reported having started to write their AD but not yet finished | 4% (n = 6/136) | 1% (n = 2/176) | 2% (n = 6/312) |