Friebert Sarah, Trujillo Rivera Eduardo A, Baker Justin N, Thompkins Jessica D, Grossoehme Daniel, Needle Jennifer, Lyon Maureen E
Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio.
Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, Ohio.
Pediatrics. 2025 Feb 1;155(2). doi: 10.1542/peds.2024-068699.
To evaluate the efficacy of Family-Centered Advance Care Planning for Teens With Cancer (FACE-TC) on adolescents' quality of life.
A clinical trial randomized adolescent-family dyads at a 2:1 ratio to either FACE-TC or control. FACE-TC dyads received 3 weekly 60-minute sessions: Lyon Pediatric Advance Care Planning Survey; Next Steps: Respecting Choices; and Five Wishes. Generalized mixed-effect models evaluated efficacy at 3, 6, and 12 months after intervention measured by FACIT-SP-Ex-V4 (meaning/peace, faith) and PROMIS pediatric (anxiety; depressive symptoms; pain interference, fatigue). Fisher exact tests assessed decisional support and preparedness.
Adolescents (n = 126) were mean age 17 years, 57% female, and 79% white. No significant differences were found between groups for faith or meaning/peace. At 12 months after intervention compared to control, FACE-TC increased anxiety (mean ratio 1.14; CI 1.04-1.25), depressive symptoms (mean ratio 1.12; CI 1.02-1.22), and pain interference (mean ratio 1.10; CI 1.00-1.20), but not at 3 or 6 months. FACE-TC increased fatigue at 3 months (mean ratio 1.13; CI 1.02-1.26), but not at 6 or 12 months. Compared to control, adolescents participating in FACE-TC agreed that "I feel prepared for the future" (76% vs 94%) and "I feel we are now on the same page" (76% vs 94%) at 3 months, but not at 12 months.
There were no significant differences in quality of life between groups until 1 year, except for fatigue. FACE-TC had late effects, increasing adolescents' anxiety, depressive symptoms, and pain interference. Reassessment at 1 year is clinically important.
评估青少年癌症患者家庭导向的预先护理计划（FACE-TC）对青少年生活质量的疗效。
一项临床试验以2:1的比例将青少年-家庭二元组随机分为FACE-TC组或对照组。FACE-TC二元组接受每周3次、每次60分钟的课程：里昂儿科预先护理计划调查；下一步：尊重选择；以及五个愿望。广义混合效应模型通过FACIT-SP-Ex-V4（意义/安宁、信念）和PROMIS儿科量表（焦虑；抑郁症状；疼痛干扰、疲劳）评估干预后3个月、6个月和12个月的疗效。Fisher精确检验评估决策支持和准备情况。
青少年（n = 126）平均年龄17岁，女性占57%，白人占79%。两组在信念或意义/安宁方面未发现显著差异。与对照组相比，干预后12个月时，FACE-TC组的焦虑（平均比值1.14；可信区间1.04 - 1.25）、抑郁症状（平均比值1.12；可信区间1.02 - 1.22）和疼痛干扰（平均比值1.10；可信区间1.00 - 1.20）有所增加，但在3个月或6个月时未出现这种情况。FACE-TC组在3个月时疲劳增加（平均比值1.13；可信区间1.02 - 1.26），但在6个月或12个月时未增加。与对照组相比，参与FACE-TC的青少年在3个月时认同“我对未来有所准备”（76%对94%）和“我觉得我们现在达成了共识”（76%对94%），但在12个月时并非如此。
在1年之前，除疲劳外，两组生活质量无显著差异。FACE-TC有后期影响，增加了青少年的焦虑、抑郁症状和疼痛干扰。1年时的重新评估具有临床重要性。
