Division of Adolescent and Young Adult Medicine, Children's National, Center for Translational Research/Children's Research Institute, Washington, DC, USA.
George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
AIDS Behav. 2020 Dec;24(12):3359-3375. doi: 10.1007/s10461-020-02909-y.
Trial tested effect of advance care planning on family/surrogates' understanding of patients' end-of-life treatment preferences longitudinally. A multisite, assessor-blinded, intent-to-treat, parallel-group, randomized controlled clinical trial in five hospital-based HIV clinics enrolled 449 participants aged 22 to 77 years during October 2013-March 2017. Patients living with HIV/family dyads were randomized at 2:1 ratio to 2 weekly ~ 60-min sessions either ACP (n = 155 dyads)-(1) ACP facilitated conversation, (2) Advance directive completion; or Control (n = 68 dyads)-(1) Developmental/relationship history, (2) Nutrition/exercise tips. ACP families/surrogates were more likely to accurately report patients' treatment preferences at Time 1 (T) and 12 months post-intervention (T) compared to controls, experiencing high congruence longitudinally (high→high transition), [63·6% vs 37·7% (difference = 25·9%, 95% CI: 11·3%, 40·4%, χ = 11·52, p = 0·01)], even as patients' preferences changed over time. ACP families/surrogates had eight times the odds of controls of having an excellent understanding of patients' treatment preferences (Adjusted Odds Ratio 7.91, 95%CI: 3.08, 20.3). Conversations matter.
该试验旨在长期评估预先医疗照护计划对家属/代理人理解患者临终治疗偏好的效果。这是一项多中心、评估者设盲、意向治疗、平行组、随机对照临床试验，于 2013 年 10 月至 2017 年 3 月在 5 家医院艾滋病门诊共纳入了 449 名年龄在 22 至 77 岁之间的患者及其家属/代理人。将携带 HIV 的患者及其家属/代理人按 2:1 的比例随机分配至 2 周 1 次、每次 60 分钟的 ACP（n=155 对）或对照组（n=68 对）。ACP 组接受以下两种干预措施：（1）促进对话；（2）预先医疗指示完成。对照组接受以下两种干预措施：（1）发展/关系史；（2）营养/运动建议。与对照组相比，接受 ACP 的家庭/代理人在 T1（基线）和干预后 12 个月（T）时更有可能准确报告患者的治疗偏好，且表现出较高的一致性（高→高转换），[63.6%比 37.7%（差值为 25.9%，95%CI：11.3%，40.4%，χ²=11.52，p=0.01）]，即使患者的偏好随时间发生变化。调整后，ACP 组家庭/代理人对患者治疗偏好有极好理解的可能性是对照组的 8 倍（调整后的优势比为 7.91，95%CI：3.08，20.3）。对话很重要。
