保真度是基础：终末期癌症预先护理计划中的干预预测因子。

Fidelity is fundamental: intervention predictors in advance care plans in terminal cancer.

机构信息

School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, New South Wales, Australia.

School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, New South Wales, Australia

出版信息

BMJ Support Palliat Care. 2019 Dec;9(4):397-403. doi: 10.1136/bmjspcare-2019-001917. Epub 2019 Sep 19.

DOI:10.1136/bmjspcare-2019-001917

PMID:31537578

Abstract

OBJECTIVES

Assessing whether interventions are implemented as intended (fidelity) is critical to establishing efficacy in clinical research yet rarely applied in advance care planning (ACP) interventions. We aimed to develop and implement a fidelity audit tool for an ACP intervention.

METHODS

We developed a fidelity audit tool assessing: (A) content; (B) quality (general communication, eliciting EOL preferences and prognostic communication); and (C) family/caregiver involvement. We audited (double-coded) 55 audio-recordings of ACP discussions delivered to advanced cancer patients and caregivers, within a clinical trial.

RESULTS

Fidelity to was high: mean=9.38/11 but lower for the of general communication (mean=12.47/20), discussion of patient preferences (mean=4.67/7), prognosis (mean=3.9/6) and family/caregiver involvement (mean=2.67/4). Older patient age and caregiver religiosity were associated with higher fidelity. Higher fidelity to was associated with the trial primary outcome of family caregiver report of patient wishes being discussed and met.

CONCLUSIONS

Fidelity to content, but not quality, of the ACP intervention is strong. Communication skills training is critical for ACP interventionists. Adherence was higher with older patients and religious carers, factors that may influence acceptance of death and readiness to undertake ACP, making the discussion easier.

TRIAL REGISTRATION NUMBER

ACTRN12613001288718.

摘要

目的

评估干预措施是否按预期实施（保真度）对于临床研究的疗效至关重要，但在预先护理计划（ACP）干预措施中很少应用。我们旨在开发和实施 ACP 干预措施的保真度审核工具。

方法

我们开发了一个保真度审核工具，评估：（A）内容；（B）质量（一般沟通、引出 EOL 偏好和预后沟通）；和（C）家庭/照顾者的参与度。我们在一项临床试验中审核了 55 次针对晚期癌症患者和照顾者的 ACP 讨论的音频记录（双重编码）。

结果

对的保真度很高：平均值为 9.38/11，但一般沟通的（平均值为 12.47/20）、讨论患者偏好的（平均值为 4.67/7）、预后的（平均值为 3.9/6）和家庭/照顾者参与度的（平均值为 2.67/4）较低。患者年龄较大和照顾者宗教信仰与较高的保真度相关。对的更高保真度与试验的主要结果相关，即家庭照顾者报告讨论了患者的意愿并满足了这些意愿。