Department of Oncology, Division of Palliative Medicine, Cumming School of Medicine, University of Calgary, AB, Canada.
Covenant Health Palliative Institute, Edmonton, AB, Canada.
Med Decis Making. 2021 Apr;41(3):292-304. doi: 10.1177/0272989X20985836. Epub 2021 Jan 15.
Patient videos about advance care planning (ACP; hereafter "Videos"), were developed to support uptake of provincial policy and address the complexity of patients' decision-making process. We evaluate self-administered ACP Videos, compare the studies' choice of outcomes, show correlations between the patients' ACP actions, and discuss implications for health care policy.
To test the efficacy of the Videos on patients' ACP/goals of care designation conversations with a health care provider.
DESIGN, SETTING, AND PARTICIPANTS: Using a 2-arm, 1:1 randomized controlled trial, we recruited outpatients with a diagnosis of kidney failure, heart failure, metastatic lung, gastrointestinal, or gynecological cancer from 22 sites. Analysis followed the intention-to-treat principle.
Videos describing the ACP process and illustrating the resuscitative, medical, and comfort levels of care.
The primary outcome was the proportion of participants who reported having an ACP/goals of care designation (GCD) conversation with a health care provider by 3 mo. Outcomes were measured using the Behaviours in Advance Care Planning and Actions Survey, an online survey capturing ACP attitudes, processes, and actions.
We analyzed 241 and 217 participants at baseline and 3 mo, respectively. The proportion of participants who had an ACP/GCD conversation with a health care provider by 3 mo was significantly different between study arms (46% intervention; 32% control; adjusted odds ratio, 1.83; = 0.032). Adjusted for the quality of conversations, there was no significant difference.
Videos as stand-alone tools do not engage individuals in high-quality ACP. Pragmatic trials are necessary to evaluate their impact on downstream outcomes when integrated into intentional, comprehensive conversations with a health care provider. Considering the strong correlation between 2 activities (physicians discussing options, patients telling health care providers preferences), policy should focus on empowering patients to initiate these conversations.
患者关于预先医疗照护计划（ACP；下文简称“视频”）的视频旨在支持省级政策的推行并解决患者决策过程的复杂性。我们评估了自主的 ACP 视频，比较了研究中选择的结果，展示了患者 ACP 行为之间的相关性，并讨论了其对医疗保健政策的影响。
通过与医疗保健提供者进行 ACP/目标关怀指定对话，测试视频对患者 ACP 的效果。
设计、地点和参与者：采用 2 臂、1:1 随机对照试验，我们从 22 个地点招募了患有肾衰竭、心力衰竭、转移性肺癌、胃肠道或妇科癌症的门诊患者。分析遵循意向治疗原则。
视频描述了 ACP 过程并说明了复苏、医疗和舒适护理水平。
主要结果是在 3 个月内报告与医疗保健提供者进行 ACP/目标关怀指定（GCD）对话的参与者比例。结果使用预先医疗保健计划行为和行动调查进行测量，这是一项在线调查，可捕捉 ACP 态度、过程和行动。
我们分别在基线和 3 个月时分析了 241 名和 217 名参与者。在 3 个月时，与研究组相比，与医疗保健提供者进行 ACP/GCD 对话的参与者比例有显著差异（46%干预组；32%对照组；调整后的优势比，1.83；P=0.032）。调整后的对话质量没有显著差异。
作为独立工具的视频不能使个人参与高质量的 ACP。需要进行实用试验，以评估当它们与医疗保健提供者的有意、全面对话相结合时，对下游结果的影响。考虑到这两个活动（医生讨论选项、患者告知医疗保健提供者偏好）之间的强相关性，政策应侧重于授权患者发起这些对话。
