A randomised controlled trial of an advance care planning intervention for patients with incurable cancer

Stephanie B. Johnson, Phyllis N. Butow, Melanie L Bell, Karen Detering, Josephine M. Clayton, William Silvester, Belinda E. Kiely, Stephen Clarke, Lisa Vaccaro, Martin R. Stockler, Phillip Beale, Natalie Fitzgerald, Martin H.N. Tattersall

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9 Scopus citations

Abstract

Background: We modified and evaluated an advance care planning (ACP) intervention, which had been shown to improve compliance with patient’s end of life (EoL) wishes, in a different patient population. Methods: Patients with incurable cancer, and a Family Member (FM), were randomised one-to-one to usual care or usual care plus an ACP intervention, between April 2014 and January 2017. Oncologists and participants were non-blinded. ACP was based on the Respecting Patient Choices model, with an offer to provide individualised ranges for typical, best-case and worst-case scenarios for survival time. Seven facilitators (two oncology nurses, two nurses and three allied health professionals) delivered the intervention within 2 weeks of study enrolment. The primary outcome measure, assessed by interviewing the FM 3 months after patient death, was the FM perception that the patient’s wishes were discussed, and met. Results: Six hundred and sixty-five patients from seven Australian metropolitan oncology centres were referred for consideration by their oncologists, 444 (67%) met the study inclusion criteria and were approached by a study researcher. Two hundred and eight patients (47%) and their FM entered the trial as dyads. Fifty-three (46%) dyads in the ACP group and 63 (54%) dyads in the usual-care group had complete primary outcome data (p = 0.16). Seventy-nine patients and 53 FMs attended an ACP discussion. Mean length of discussion was 57 min. FMs from 23 (43%) dyads allocated to ACP and 21 (33%) dyads allocated usual care reported the patient’s EoL wishes were discussed and met (difference 10%, 95% CI: −2 to 8, p = 0.27). There were no differences in EoL care received, patient satisfaction with care; FM satisfaction with care or with death; or FM well being. Rates of palliative care referral were high in both groups (97% vs 96%). Conclusions: A formal ACP intervention did not increase the likelihood that EoL care was consistent with patients’ preferences.

Original languageEnglish (US)
JournalBritish Journal of Cancer
DOIs
StateAccepted/In press - Jan 1 2018

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Johnson, S. B., Butow, P. N., Bell, M. L., Detering, K., Clayton, J. M., Silvester, W., Kiely, B. E., Clarke, S., Vaccaro, L., Stockler, M. R., Beale, P., Fitzgerald, N., & Tattersall, M. H. N. (Accepted/In press). A randomised controlled trial of an advance care planning intervention for patients with incurable cancer. British Journal of Cancer. https://doi.org/10.1038/s41416-018-0303-7