Collaborative advance care planning in palliative care: a randomised controlled trial

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Carola Seifart - , Philipps-Universität Marburg (Autor:in)
  • Martin Koch - , Medizinische Klinik und Poliklinik I, Klinik und Poliklinik für Kinder- und Jugendmedizin (Autor:in)
  • Svenja Herzog - , Central Hospital of the Detention Center Hamburg, Hamburg, Germany. (Autor:in)
  • Nico Leppin - , Philipps-Universität Marburg (Autor:in)
  • Katharina Nagelschmidt - , Philipps-Universität Marburg (Autor:in)
  • Jorge Riera Knorrenschild - , Philipps-Universität Marburg (Autor:in)
  • Nina Timmesfeld - , Ruhr-Universität Bochum (Autor:in)
  • Robin Denz - , Ruhr-Universität Bochum (Autor:in)
  • Ulf Seifart - , Klinik Sonnenblick (Autor:in)
  • Winfried Rief - , Philipps-Universität Marburg (Autor:in)
  • Pia Von Blanckenburg - , Philipps-Universität Marburg (Autor:in)

Abstract

OBJECTIVE: An effective tool for establishing concordant end-of-life (EOL) care in patients with cancer is advance care planning (ACP). However, various barriers, including psychological obstacles, hamper the access to ACP. Therefore, a new conceptual model combining a psycho-oncological approach with structured ACP was developed. The effectiveness and efficiency of this new concept of collaborative ACP (col-ACP) is evaluated in the present randomised controlled trial in patients with palliative cancer.

METHODS: 277 patients with palliative cancer and their relatives were randomised into three groups (1) collaborative ACP (col-ACP) consisting of a psycho-oncological approach addressing barriers to EOL conversations followed by a standardised ACP procedure, (2) supportive intervention (active control) and (3) standard medical care.

RESULTS: Patients in the col-ACP group completed advance directives (p<0.01) and healthcare proxies (p<0.01) significantly more often. Additionally, they felt better planned ahead for their future treatment (p<0.01) and were significantly more confident that their relatives were aware of their treatment wishes (p=0.03). In fact, their goals of care were known and highly fulfilled. However, patients' and caregivers' quality of life, patients' stress, depression and peace did not differ between the groups.

CONCLUSIONS: The new, well-received, concept of col-ACP improves readiness and access to ACP and results in more consistent EOL care. Further, even if no direct influence on quality of life could be proven, it supports patients in planning their treatment, making autonomous decisions and regaining self-efficacy in the face of life-limiting cancer. Therefore, a closer interlocking and information exchange between psycho-oncological and ACP services seems to be reasonable.

TRIAL REGISTRATION NUMBER: NCT03387436.

Details

OriginalspracheEnglisch
FachzeitschriftBMJ supportive & palliative care
PublikationsstatusElektronische Veröffentlichung vor Drucklegung - 2 Juli 2024
Peer-Review-StatusJa

Externe IDs

Scopus 85197654928
ORCID /0009-0003-4333-8204/work/169643495

Schlagworte

Ziele für nachhaltige Entwicklung