University of New South Wales, Sydney, NSW, Australia.
University of Western Australia, Perth, WA, Australia.
J Pain Symptom Manage. 2020 Apr;59(4):848-855. doi: 10.1016/j.jpainsymman.2019.11.018. Epub 2019 Nov 30.
Previous work has found that facilitated advance care planning (ACP) interventions are effective in increasing ACP uptake among patients with severe respiratory disease.
The objective of this study was to investigate whether a nurse-led, facilitated ACP intervention among participants with severe respiratory disease impacts self-reported or clinical outcomes.
A multicenter, open-label, patient-preference, randomized controlled trial of a nurse-led facilitated ACP intervention was performed. Outcome measures included self-report scales (health care satisfaction and EQ-5D-5L health-related quality of life at three- and six-month follow-up), 12-month mortality, and health care utilization during the final 90 days of life.
One hundred forty-nine participants were recruited across two study settings (metropolitan tertiary hospital respiratory department and rural sites) and 106 were allocated to receive the ACP intervention. There was no effect of the intervention on satisfaction with health care, health-related quality of life, or 12-month mortality rates. Among those participants who died during the follow-up period (N = 54), those allocated to the ACP intervention had significantly fewer outpatient consultations (7.51 vs. 13.6, P < 0.001). There were no changes in emergency department attendances, total hospital admissions or length of stay, or home nursing visits. Among those allocated to the ACP intervention, there was a reduced length of stay in acute hospital settings (7.76 vs. 11.5 nights, P < 0.001) and increased length of stay in palliative hospital settings (5.54 vs. 2.08, P < 0.001) during the final 90 days of life.
A facilitated ACP intervention among patients with severe respiratory disease did not have an impact on satisfaction, health-related quality of life, or 12-month mortality rate. Facilitated ACP may be associated with a different type of health care utilization during the end-of-life period.
先前的研究发现，促进式预先医疗照护计划（ACP）干预措施可有效提高患有严重呼吸系统疾病患者的 ACP 参与率。
本研究旨在探究针对严重呼吸系统疾病患者的护士主导、促进式 ACP 干预措施是否会影响自我报告或临床结局。
进行了一项多中心、开放性标签、患者偏好、随机对照试验，评估了护士主导的促进式 ACP 干预措施。结局指标包括自我报告量表（医疗满意度和 EQ-5D-5L 健康相关生活质量，分别在 3 个月和 6 个月时进行随访）、12 个月死亡率以及生命最后 90 天的医疗保健利用率。
在两个研究环境（大都市三级医院呼吸科和农村地区）共招募了 149 名参与者，其中 106 名参与者被分配接受 ACP 干预措施。干预措施对医疗满意度、健康相关生活质量或 12 个月死亡率无影响。在随访期间死亡的参与者（n=54）中，接受 ACP 干预的参与者门诊就诊次数明显减少（7.51 次 vs. 13.6 次，P<0.001）。急诊就诊、总住院次数或住院时间或家庭护理访问次数均无变化。在接受 ACP 干预的参与者中，急性医院环境中的住院时间缩短（7.76 天 vs. 11.5 天，P<0.001），姑息治疗医院环境中的住院时间延长（5.54 天 vs. 2.08 天，P<0.001）。
针对严重呼吸系统疾病患者的促进式 ACP 干预措施对满意度、健康相关生活质量或 12 个月死亡率无影响。促进式 ACP 可能与生命末期的医疗保健利用类型不同有关。
