Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Palliat Med. 2020 Aug;23(8):1076-1083. doi: 10.1089/jpm.2019.0512. Epub 2020 Apr 15.
Advance care planning is an important component of quality palliative care. In Asian countries, few randomized clinical trials have been reported. This pilot randomized-controlled trial examined the effects of brief nurse intervention with visual materials on the goal-of-care preference, cardiopulmonary resuscitation (CPR) preference, and designation of a health care proxy. This randomized clinical trial was performed from January to February 2018 on elderly Japanese patients with chronic disease. The patients were randomly assigned to a control group (brief nurse intervention using verbal descriptions) or intervention group (using visual materials). The primary endpoint was goal-of-care preference, and secondary outcomes included the following: (1) CPR preference, (2) presence of a designated health care proxy, (3) knowledge of CPR, and (4) readiness for advance care planning. Outcome measures were obtained at baseline and just after completion of the intervention. A total of 220 patients were enrolled (117 in the intervention group and 103 in the control group). All patients completed post-intervention measurement. There was no significant difference between the groups in any of the outcome measures, while <5% of the participants wanted life-prolonging care as the goal of care at the baseline. Before/after comparisons indicated that, in both groups, the number of participants who designated a health care proxy significantly increased (29% to 65% vs. 22% to 52%, respectively; < 0.001 each); and the knowledge and readiness scores significantly increased. Moreover, there was a significant increase in the number of patients who did not want CPR (55% to 67% with a terminal condition, = 0.003; 67% to 80% with a bedridden condition, < 0.001) in the intervention group. Brief nurse intervention increased documentation of a patient-designated health care proxy and improved the knowledge of CPR and patient readiness. Visual materials might help patients to imagine the actual situation regarding CPR.
预先医疗照护计划是优质缓和医疗的重要组成部分。亚洲国家鲜有随机临床试验的报道。这项初步随机对照试验旨在评估附有视觉材料的护士简短干预对患者医疗照护目标、心肺复苏术（CPR）意愿和指定医疗代理人偏好的影响。这项随机临床试验于 2018 年 1-2 月在患有慢性病的日本老年患者中进行。患者被随机分为对照组（使用口头描述的护士简短干预）或干预组（使用视觉材料）。主要终点是医疗照护目标，次要结局包括：（1）CPR 意愿；（2）指定医疗代理人的存在；（3）CPR 知识；（4）预先医疗照护计划的准备情况。在基线和干预完成后立即获得结局测量。共纳入 220 例患者（干预组 117 例，对照组 103 例），所有患者均完成了干预后测量。两组在任何结局测量中均无显著差异，而在基线时，不到 5%的患者希望将延长生命作为医疗照护目标。组内前后比较表明，两组中指定医疗代理人的患者数量均显著增加（分别从 22%增至 52%和从 29%增至 65%；均<0.001），知识和准备程度评分也显著增加。此外，干预组中不希望接受心肺复苏术的患者数量显著增加（终末期从 55%增至 67%，=0.003；卧床不起患者从 67%增至 80%，<0.001）。护士简短干预增加了患者指定医疗代理人的记录，并提高了患者对 CPR 的了解和准备程度。视觉材料可能有助于患者想象有关 CPR 的实际情况。
