School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
BMJ Open. 2019 Jan 24;9(1):e023107. doi: 10.1136/bmjopen-2018-023107.
It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being.
Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be ≥18 years screened as potentially having palliative care needs and at risk of dying in 6-12 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient's health-related quality-of-life and quality of chronic disease care; (ii) caregiver's health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff's self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention.
Approved by South-East Sydney Local Health District Human Research Ethics Committee and NSW Population and Health Services Research Ethics Committee. Results will be disseminated via conference presentations, journal publications, seminars and invited talks.
ACTRN12617000280303.
目前尚不清楚在社区中与患者一起进行的预先护理计划（ACP）是否可以改善患者的护理并避免不必要的干预和住院。我们设计了一项随机对照试验（RCT），以检验在接受医院门诊治疗的晚期疾病患者中进行 ACP 是否可以减少计划外的住院，并改善患者和护理人员的幸福感。
这是一项在澳大利亚悉尼五个临床地点的专科门诊参与的实用 RCT。参与者将被筛选为≥18 岁，有姑息治疗需求并可能在 6-12 个月内死亡的患者。这些患者将被随机分配到干预组或对照组。干预组将由经过培训的卫生专业人员进行 ACP 讨论。对照组将收到有关 ACP 的书面信息，这代表当前的护理标准。主要结果是在 6 个月随访时计划外住院的人数。次要结果包括：（i）患者的健康相关生活质量和慢性疾病护理质量；（ii）护理人员的健康相关生活质量和护理人员负担；（iii）其他健康结果，包括救护车使用，急诊就诊，住院，复苏尝试，重症监护病房入院，死亡，在患者记录中记录患者的意愿以及对 ACP 讨论和文件的审核。还将测量工作人员对 ACP 的自我报告态度和知识。将通过自我报告问卷，医院记录审核，ACP 文件审核和数据链接分析来收集数据。将对患者，护理人员和医疗保健专业人员进行半结构化访谈和焦点小组讨论，以探讨干预措施的可接受性和可行性。
该研究已获得东南悉尼地方卫生区人体研究伦理委员会和新南威尔士州人口与卫生服务研究伦理委员会的批准。研究结果将通过会议演讲，期刊发表，研讨会和特邀演讲进行传播。
ACTRN12617000280303。
