1 Palliative Care Section, Department of Medicine, Stanford University School of Medicine, Stanford, California.
2 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
J Palliat Med. 2019 Jul;22(7):764-772. doi: 10.1089/jpm.2018.0209. Epub 2019 Apr 9.
Preoperative advance care planning (ACP) may benefit patients undergoing major surgery. To evaluate feasibility, safety, and early effectiveness of video-based ACP in a surgical population. Randomized controlled trial with two study arms. Single, academic, inner-city tertiary care hospital. Patients undergoing major cancer surgery were recruited from nine surgical clinics. Of 106 consecutive potential participants, 103 were eligible and 92 enrolled. In the intervention arm, patients viewed an ACP video developed by patients, surgeons, palliative care clinicians, and other stakeholders. In the control arm, patients viewed an informational video about the hospital's surgical program. Primary Outcomes-ACP content and patient-centeredness in patient-surgeon preoperative conversation. Secondary outcomes-patient Hospital Anxiety and Depression Scale (HADS) score; patient goals of care; patient and surgeon satisfaction; video helpfulness; and medical decision maker designation. Ninety-two patients (target enrollment: 90) were enrolled. The ACP video was successfully integrated with no harm noted. Patient-centeredness was unchanged (incidence rate ratio [IRR] = 1.06, confidence interval [0.87-1.3], = 0.545), although there were more ACP discussions in the intervention arm (23% intervention vs. 10% control, = 0.18). While slightly underpowered, study results did not signal that further enrollment would have yielded statistical significance. There were no differences in secondary outcomes other than the intervention video was more helpful ( = 0.007). The ACP video was successfully integrated into surgical care without harm and was thought to be helpful, although video content did not significantly change the ACP content or patient-surgeon communication. Future studies could increase the ACP dose through modifying video content and/or who presents ACP. Trial Registration: clinicaltrials.gov Identifier NCT02489799.
术前预先医疗照护计划（ACP）可能使接受大手术的患者受益。评估视频为基础的 ACP 在外科人群中的可行性、安全性和早期效果。一项有两个研究组的随机对照试验。单一、学术性、城市内的三级保健医院。从 9 个外科诊室招募接受主要癌症手术的患者。在 106 名连续潜在参与者中，103 名符合条件，92 名入组。在干预组中，患者观看了由患者、外科医生、姑息治疗临床医生和其他利益相关者开发的 ACP 视频。在对照组中，患者观看了关于医院外科项目的信息视频。主要结果-术前医患对话中的 ACP 内容和以患者为中心。次要结果-患者医院焦虑和抑郁量表（HADS）评分；患者的医疗目标；患者和外科医生的满意度；视频的有用性；以及医疗决策者的指定。92 名患者（目标入组：90 名）入组。ACP 视频成功整合，未发现任何伤害。以患者为中心没有改变（发生率比 [IRR] = 1.06，置信区间 [0.87-1.3]，= 0.545），尽管干预组的 ACP 讨论更多（23%干预组与 10%对照组，= 0.18）。尽管研究结果表明，进一步入组不会产生统计学意义，但仍存在轻微的效能不足。除了干预视频更有帮助（= 0.007）外，其他次要结果没有差异。ACP 视频成功地整合到外科护理中，没有造成伤害，并且被认为是有帮助的，尽管视频内容并没有显著改变 ACP 内容或医患沟通。未来的研究可以通过修改视频内容和/或谁来呈现 ACP 来增加 ACP 的剂量。试验注册：clinicaltrials.gov 标识符 NCT02489799。
