School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts Western Switzerland, Friourg, Switzerland
Geneva Institution for Homecare and Assistance (imad), Geneva, Switzerland.
BMJ Open. 2020 Sep 20;10(9):e037144. doi: 10.1136/bmjopen-2020-037144.
Discussing the evolution of life-threatening diseases and end-of-life issues remains difficult for patients, relatives and professionals. Helping people discuss and formalise their preferences in end-of-life care, as planned in the Go Wish intervention, could reduce health-related anxiety in the advance care planning (ACP) and advance directive (AD) process. The aims of this study are (1) to test the effectiveness of the Go Wish intervention among outpatients in early-stage palliative care and (2) to understand the role of defence mechanisms in end-of-life discussions among nurses, patients and relatives.
A mixed-methods study will be performed. A cluster randomised controlled trials with three parallel arms will be conducted with 45 patients with chronic progressive diseases impacting life expectancy in each group: (1) Group A, Go Wish intervention for patients and their relatives; (2) Group A, Go Wish intervention for patients alone and (3) Group B, for patients (with a waiting list), who will receive the standardised information on ADs (usual care). Randomisation will be at the nurse level as each patient is referred to one of the 20 participating nurses (convenience sample of 20 nurses). A qualitative study will be conducted to understand the cognitive and emotional processes and experiences of nurses, patients and relatives confronted with end-of-life discussions. The outcome measurements include the completion of ADs (yes/no), anxiety, quality of communication about end-of-life care, empowerment, quality of life and attitudes towards ADs.
The study protocol has been approved by the Human Research Ethics Committee of the Canton of Geneva, Switzerland (no. 2019-00922). The findings will be disseminated to practice (nurses, patients and relatives), to national and international scientific conferences, and peer-reviewed journals covering nursing science, psychology and medicine.
NCT04065685.
讨论危及生命的疾病和生命末期问题的演变仍然让患者、亲属和专业人员感到困难。帮助人们讨论并正式确定他们在生命末期护理方面的偏好，就像 Go Wish 干预措施所计划的那样，可以减少预先护理计划 (ACP) 和预先指示 (AD) 过程中的与健康相关的焦虑。本研究的目的是 (1) 在早期姑息治疗的门诊患者中测试 Go Wish 干预措施的有效性，以及 (2) 了解防御机制在护士、患者和亲属之间进行生命末期讨论中的作用。
将进行一项混合方法研究。一项具有三个平行臂的集群随机对照试验将在每组中进行，每组有 45 名患有影响预期寿命的慢性进行性疾病的患者：(1) 组 A，患者及其亲属的 Go Wish 干预措施；(2) 组 A，仅患者的 Go Wish 干预措施和 (3) 组 B，患者（有候补名单），他们将接受 AD 标准信息（常规护理）。随机化将在护士层面进行，因为每位患者都会被转介给 20 名参与护士之一（20 名护士的便利样本）。将进行一项定性研究，以了解护士、患者和亲属在面临生命末期讨论时的认知和情感过程和经验。主要结局测量包括 AD 的完成情况（是/否）、焦虑、关于生命末期护理的沟通质量、赋权、生活质量和对 AD 的态度。
该研究方案已获得瑞士日内瓦州人类研究伦理委员会的批准（编号：2019-00922）。研究结果将传播给实践（护士、患者和亲属）、国家和国际科学会议以及涵盖护理科学、心理学和医学的同行评审期刊。
NCT04065685。
