Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Clin Gastroenterol Hepatol. 2022 Oct;20(10):2287-2295.e3. doi: 10.1016/j.cgh.2021.10.027. Epub 2021 Oct 27.
BACKGROUND & AIMS: Transplant-ineligible patients with advanced liver disease rarely receive timely advance care planning (ACP). Tools are needed to educate these patients about medical interventions available at the end of life to promote ACP.
This single-site pilot randomized controlled trial assessed the feasibility, acceptability, and preliminary efficacy of an ACP video decision support tool for improving transplant-ineligible advanced liver disease patients' knowledge about and preferences for end-of-life care. Intervention participants watched a 5-minute video depicting 3 levels of goals of care: life-prolonging care (cardiopulmonary resuscitation [CPR] and intubation), life-limiting care (hospitalization, no CPR/intubation), and comfort care. Control subjects received only a verbal narrative of these 3 levels of goals of care. The primary outcome was feasibility (≥60% enrollment rate). Secondary outcomes included acceptability of the video, patients' knowledge of end-of-life care options (6-item test; range, 0-6), and postintervention goals-of-care and CPR or intubation preferences.
We enrolled 85% (n = 50 of 59) of eligible patients randomized to the video (n = 26) or verbal (n = 24) arm. In the video arm, 81% of patients reported being very comfortable watching the video. Patients in the video arm had higher mean knowledge scores (5.7 vs 4.8; P < .001) and were less likely to prefer to receive CPR compared with patients in the verbal arm (35% vs 63%; P = .09).
An ACP video decision support tool to improve knowledge about and preferences for end-of-life care is both feasible and highly acceptable to transplant-ineligible patients with advanced liver disease with a high enrollment rate and promising preliminary efficacy. Future studies should examine the efficacy of the ACP video for enhancing the quality of their end-of-life care. (ClinicalTrials.gov, Number: NCT03557086).
不适合进行移植的晚期肝病患者很少接受及时的预先护理计划（ACP）。需要有工具来教育这些患者有关生命末期可用的医疗干预措施，以促进 ACP。
这项单站点的试点随机对照试验评估了 ACP 视频决策支持工具用于改善不适合进行移植的晚期肝病患者对终末期护理的知识和偏好的可行性、可接受性和初步疗效。干预组参与者观看了一个 5 分钟的视频，描述了 3 种目标护理水平：延长生命的护理（心肺复苏术 [CPR] 和插管）、限制生命的护理（住院治疗，不进行 CPR/插管）和舒适护理。对照组仅接受了这 3 种目标护理水平的口头叙述。主要结局是可行性（≥60%的入组率）。次要结局包括视频的可接受性、患者对终末期护理选择的知识（6 项测试；范围，0-6）以及干预后的目标护理和 CPR 或插管偏好。
我们招募了符合条件的患者的 85%（n=50/59）随机分配到视频（n=26）或口头（n=24）组。在视频组中，81%的患者表示非常舒适地观看了视频。与口头组的患者相比，视频组的患者的平均知识得分更高（5.7 对 4.8；P < 0.001），并且不太可能选择接受 CPR（35%对 63%；P=0.09）。
ACP 视频决策支持工具可提高对终末期护理的认识和偏好，对不适合进行移植的晚期肝病患者具有较高的可行性和可接受性，入组率高，初步疗效有希望。未来的研究应研究 ACP 视频对提高其生命末期护理质量的疗效。（ClinicalTrials.gov，编号：NCT03557086）。
