Respecting Patient Choices Program, Austin Health, PO Box 555, Heidelberg, Victoria, Australia.
BMJ. 2010 Mar 23;340:c1345. doi: 10.1136/bmj.c1345.
To investigate the impact of advance care planning on end of life care in elderly patients.
Prospective randomised controlled trial.
Single centre study in a university hospital in Melbourne, Australia.
309 legally competent medical inpatients aged 80 or more and followed for six months or until death.
Participants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes.
The primary outcome was whether a patient's end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in relatives of patients who died.
154 of the 309 patients were randomised to advance care planning, 125 (81%) received advance care planning, and 108 (84%) expressed wishes or appointed a surrogate, or both. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (25/29, 86%) compared with the control group (8/27, 30%; P<0.001). In the intervention group, family members of patients who died had significantly less stress (intervention 5, control 15; P<0.001), anxiety (intervention 0, control 3; P=0.02), and depression (intervention 0, control 5; P=0.002) than those of the control patients. Patient and family satisfaction was higher in the intervention group.
Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives. Trial registration Australian New Zealand clinical trials registry ACTRN12608000539336.
调查预先护理计划对老年患者临终关怀的影响。
前瞻性随机对照试验。
澳大利亚墨尔本一所大学医院的单中心研究。
309 名法定能力的 80 岁及以上住院患者，随访 6 个月或直至死亡。
参与者被随机分配接受常规护理或常规护理加促进预先护理计划。预先护理计划旨在帮助患者反思他们的目标、价值观和信念；考虑未来的医疗治疗偏好；指定代理人；并记录他们的意愿。
主要结果是患者的临终愿望是否已知并得到尊重。其他结果包括患者和家属对住院的满意度以及患者死亡的家属的压力、焦虑和抑郁水平。
309 名患者中，154 名被随机分配到预先护理计划组，125 名（81%）接受了预先护理计划，108 名（84%）表达了意愿或指定了代理人，或两者兼有。在 6 个月内死亡的 56 名患者中，干预组（29/29，86%）比对照组（27/27，30%）更有可能知道并遵循临终愿望（P<0.001）。在干预组中，死亡患者的家属的压力（干预组 5 例，对照组 15 例；P<0.001）、焦虑（干预组 0 例，对照组 3 例；P=0.02）和抑郁（干预组 0 例，对照组 5 例；P=0.002）明显低于对照组患者。干预组的患者和家属满意度更高。
预先护理计划可改善临终关怀以及患者和家属的满意度，并降低存活亲属的压力、焦虑和抑郁。
澳大利亚新西兰临床试验注册 ACTRN12608000539336。
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