Family-Centered Advance Care Planning for Teens With Cancer
Family-Centered Advance Care Planning for Teens With Cancer
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DOI：
10.1001/jamapediatrics.2013.943
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发表时间：
2013-05-01
期刊：
影响因子：
26.1
通讯作者：
Wang, Jichuan
中科院分区：
文献类型：
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作者：
Lyon, Maureen E.;Jacobs, Shana;Wang, Jichuan
重要性：提前护理计划(ACP)使患者及其家人为未来的卫生保健决策做好准备；然而，青少年肿瘤患者参与ACP的需求尚未得到很好的研究。目的：检验以家庭为中心的ACP的有效性。设计和背景：儿科肿瘤计划中的两组随机对照试验。参与者：60名14-21岁的青少年癌症患者及其代理人或家人在2011年1月17日至2012年3月29日期间参加了这项研究。干预：30名青少年接受3-60分钟的疗程，每周一次。干预二人组完成了(1)里昂以家庭为中心的ACP调查，(2)尊重选择的访谈，以及(3)五个愿望。结果：青少年的平均年龄为16岁，其中男性36例(60%)，白人30例(50%)，黑人26例(43%)，亚裔4例(7%)。诊断如下：白血病14例(47%)，脑肿瘤8例(27%)，实体瘤6例(20%)，淋巴瘤2例(7%)。在6种特定疾病的情景中，有4种情况下，干预对偶的一致性显著高于对照组；例如，在情景2(“治疗将使我的生命延长不超过2-3个月”)中，干预对偶表现出更高的一致性(kappa=0.660；P
Importance: Advance care planning (ACP) prepares patients and their families for future health care decisions; however, the needs of adolescent oncology patients for participation in ACP have not been well studied.Objective: To examine the efficacy of family-centered ACP.Design and Setting: Two-group randomized controlled trial in a pediatric oncology program.Participants: Sixty adolescents aged 14 to 21 years with cancer and their surrogates or families were enrolled in the study between January 17, 2011, and March 29, 2012.Intervention: Thirty dyads received 3- to 60-minute sessions 1 week apart. Intervention dyads completed (1) the Lyon Family-Centered ACP Survey, (2) the Respecting Choices interview, and (3) Five Wishes. Control subjects received standard care plus information.Main Outcome Measures: Statement of treatment preferences and Decisional Conflict Scale score.Results: The mean age of the adolescents was 16 years; 36 (60%) were male, 30 (50%) white, 26 (43%) black, and 4 (7%) Asian. Diagnoses were as follows: leukemia (14 patients [47%]), brain tumor (8 [27%]), solid tumor (6 [20%]), and lymphoma (2 [7%]). Significantly increased congruence was observed for intervention dyads compared with controls for 4 of the 6 disease-specific scenarios; for example, for situation 2 ("treatment would extend my life by not more than 2 to 3 months"), intervention dyads demonstrated higher congruence (kappa = 0.660; P