Ann Fam Med. 2020 Mar;18(2):110-117. doi: 10.1370/afm.2471.
Online programs may help to engage patients in advance care planning in outpatient settings. We sought to implement an online advance care planning program, PREPARE (Prepare for Your Care; http://www.prepareforyourcare.org), at home and evaluate the changes in advance care planning engagement among patients attending outpatient clinics.
We undertook a prospective before-and-after study in 15 primary care clinics and 2 outpatient cancer centers in Canada. Patients were aged 50 years or older (primary care) or 18 years or older (cancer care) and free of cognitive impairment. They used the PREPARE website over 6 weeks, with reminders sent at 2 or 4 weeks. We used the 55-item Advance Care Planning Engagement Survey, which measures behavior change processes (knowledge, contemplation, self-efficacy, readiness) on 5-point scales and actions relating to substitute decision makers, quality of life, flexibility for the decision maker, and asking doctors questions on an overall scale from 0 to 21; higher scores indicate greater engagement.
In total, 315 patients were screened and 172 enrolled, of whom 75% completed the study (mean age = 65.6 years, 51% female, 35% had cancer). The mean behavior change process score was 2.9 (SD 0.8) at baseline and 3.5 (SD 0.8) at follow-up (mean change = 0.6; 95% CI, 0.49-0.73); the mean action measure score was 4.0 (SD 4.9) at baseline and 5.2 (SD 5.4) at follow-up (mean change = 1.2; 95% CI, 0.54-1.77). The effect size was moderate (0.75) for the former and small (0.23) for the latter. Findings were similar in both primary care and cancer care populations.
Implementation of the online PREPARE program in primary care and cancer care clinics increased advance care planning engagement among patients.
在线项目可能有助于在门诊环境中使患者参与预先护理计划。我们试图在家中实施在线预先护理计划项目 PREPARE（准备您的护理；http://www.prepareforyourcare.org），并评估门诊患者参与预先护理计划的变化。
我们在加拿大的 15 个初级保健诊所和 2 个门诊癌症中心进行了前瞻性的前后研究。患者年龄在 50 岁及以上（初级保健）或 18 岁及以上（癌症保健），且无认知障碍。他们在 6 周内使用 PREPARE 网站，并在 2 或 4 周时发送提醒。我们使用 55 项预先护理计划参与调查，该调查使用 5 分制衡量行为改变过程（知识、思考、自我效能、准备就绪），以及与替代决策者、生活质量、决策者的灵活性和向医生询问有关问题的整体评分，总分为 0 至 21 分；得分越高表示参与度越高。
共筛选了 315 名患者，有 172 名患者入组，其中 75%完成了研究（平均年龄=65.6 岁，51%为女性，35%患有癌症）。基线时行为改变过程的平均得分为 2.9（SD 0.8），随访时为 3.5（SD 0.8）（平均变化=0.6；95%CI，0.49-0.73）；基线时行动措施的平均得分为 4.0（SD 4.9），随访时为 5.2（SD 5.4）（平均变化=1.2；95%CI，0.54-1.77）。前者的效果大小为中等（0.75），后者的效果大小为小（0.23）。初级保健和癌症保健人群的结果相似。
在初级保健和癌症保健诊所实施在线 PREPARE 计划增加了患者对预先护理计划的参与度。
