From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (CKT); Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO (CKT, CR); Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (SJ,PS,HDL); Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA (RSL).
J Am Board Fam Med. 2024 Mar-Apr;37(2):215-227. doi: 10.3122/jabfm.2023.230187R2.
Although interventions can increase advance care planning (ACP) engagement, it remains unclear which interventions to choose in primary care settings. This study compares a passive intervention (mailed materials) to an interactive intervention (group visits) on participant ACP engagement and experiences.
We used mixed methods to examine ACP engagement at baseline and six months following two ACP interventions. Eligible patients were randomized to receive mailed materials or participate in two ACP group visits. We administered the 4-item ACP Engagement survey (n = 110) and conducted interviews (n = 23). We compared mean scores and percent change in ACP engagement, analyzed interviews with directed content analysis to understand participants' ACP experiences, and integrated the findings based on mailed materials or group visits intervention.
All participants demonstrated increased ACP engagement scores. At six months, group visit participants reported higher percent change in mean overall score compared with mailed materials participants (+8% vs +3%, ). Group visits participants reported that being prompted to think about end-of-life preferences, gaining knowledge about ACP, and understanding the value of completing ACP documentation influenced their ACP readiness. While both interventions encouraged patients to start considering and refining their end-of-life preferences, group visits made patients feel more knowledgeable about ACP, highlighted the importance of completing ACP documentation early, and sparked further ACP discussions with others.
While primary care patients may benefit from mailed ACP materials, patients reported increased readiness after ACP group visits. Group visits emphasized the value of upstream preparation, ongoing conversations, and increased knowledge about ACP.
尽管干预措施可以提高预先医疗照护计划（ACP）的参与度，但在基层医疗环境中，仍不清楚应选择哪种干预措施。本研究比较了被动干预（邮寄材料）和主动干预（小组访问）对参与者 ACP 参与度和体验的影响。
我们采用混合方法，在接受两种 ACP 干预措施后，分别在基线和 6 个月时评估 ACP 参与度。合格的患者被随机分配接受邮寄材料或参加两次 ACP 小组访问。我们采用 4 项 ACP 参与度调查（n=110）和访谈（n=23）。我们比较了 ACP 参与度的平均得分和变化百分比，对访谈进行了定向内容分析，以了解参与者的 ACP 体验，并根据邮寄材料或小组访问干预措施整合了研究结果。
所有参与者的 ACP 参与度得分均有所提高。在 6 个月时，小组访问参与者的平均总分变化百分比高于邮寄材料参与者（+8%比+3%）。小组访问参与者表示，被提示思考临终偏好、获得有关 ACP 的知识以及理解完成 ACP 文件记录的价值，影响了他们的 ACP 准备程度。虽然两种干预措施都鼓励患者开始考虑和完善他们的临终偏好，但小组访问使患者对 ACP 有了更多的了解，强调了尽早完成 ACP 文件记录的重要性，并引发了与他人的进一步 ACP 讨论。
尽管初级保健患者可能受益于邮寄的 ACP 材料，但患者在接受 ACP 小组访问后报告了更高的准备度。小组访问强调了上游准备、持续对话和增加对 ACP 了解的重要性。
