Torke Alexia M, Hickman Susan, Wocial Lucia, Monahan Patrick O, Burke Emily S, Slaven James, Ziemba Kathleen, Montgomery Carole, Koch Sarah, Cavanaugh Melissa, Fox Ludden Emily
Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA.
BMJ Open. 2025 May 24;15(5):e102186. doi: 10.1136/bmjopen-2025-102186.
An important goal of advance care planning (ACP) is ensuring that patients receive care concordant with their preferences. High-quality evidence is needed about the effect of ACP on this and other outcomes.
Planning Ahead is a randomised controlled trial to test the effectiveness of facilitated ACP in community-dwelling older adults including those with normal cognition and those with Alzheimer's Disease and Related Dementias (ADRD) who are at high risk of death. The primary aim is to determine the effect of the intervention on discordance between preferences for medical treatments and the treatments received in the year after the intervention. Secondary outcomes include decision-making quality, care at the end of life and cost. Eligible patients have a primary care provider at one of two Midwest health systems, have an approximate 33% mortality risk and do not have a POLST form at baseline. Patients with capacity can invite the person they would choose to be their healthcare decision maker to participate as a study partner. A surrogate decision maker enrols and receives the intervention for patients who lack capacity due to ADRD. The intervention uses the Respecting Choices Advanced Steps (RCAS) model of ACP delivered by a registered nurse and includes identification of the patient's values and goals, education about ACP and the POLST form and the opportunity to complete a POLST form.
The study is approved by the Indiana University Institutional Review Board. Primary and secondary analyses will be published in peer-reviewed journals. We also plan dissemination through the media. We will construct a deidentified data set that could be available to other researchers. Survey data will be preserved and shared via the NIH-supported National Archive of Computerised Data on Ageing's (NACDA) Open Ageing Repository (OAR).
NCT04070183.
预先护理计划（ACP）的一个重要目标是确保患者接受符合其偏好的护理。需要高质量的证据来证明ACP对这一结果及其他结果的影响。
“提前规划”是一项随机对照试验，旨在测试在社区居住的老年人中开展的辅助性ACP的有效性，这些老年人包括认知正常者以及患有阿尔茨海默病和相关痴呆症（ADRD）且死亡风险较高者。主要目的是确定干预措施对干预后一年内医疗治疗偏好与所接受治疗之间不一致性的影响。次要结果包括决策质量、临终护理和成本。符合条件的患者在中西部两个医疗系统之一中有一名初级保健提供者，基线时死亡风险约为33%且没有POLST表格。有行为能力的患者可以邀请他们选择的作为其医疗保健决策者的人作为研究伙伴参与。替代决策者为因ADRD而缺乏行为能力的患者登记并接受干预。干预采用由注册护士提供的“尊重选择高级步骤”（RCAS）ACP模型，包括确定患者的价值观和目标、关于ACP和POLST表格的教育以及填写POLST表格的机会。
该研究已获得印第安纳大学机构审查委员会的批准。主要和次要分析将发表在同行评审期刊上。我们还计划通过媒体进行传播。我们将构建一个去识别化的数据集，可供其他研究人员使用。调查数据将通过美国国立卫生研究院支持的国家老龄化计算机化数据档案库（NACDA）的开放老龄化知识库（OAR）进行保存和共享。
NCT04070183。
