A Longitudinal, Randomized, Controlled Trial of Advance Care Planning for Teens With Cancer: Anxiety, Depression, Quality of Life, Advance Directives, Spirituality
A Longitudinal, Randomized, Controlled Trial of Advance Care Planning for Teens With Cancer: Anxiety, Depression, Quality of Life, Advance Directives, Spirituality
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DOI：
10.1016/j.jadohealth.2013.10.206
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发表时间：
2014-06-01
影响因子：
7.6
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
目的：探讨以家庭为中心的青少年癌症预先护理计划（Family-Centered advance care planning for Teens With Cancer, FACE-TC）的可行性、可接受性和安全性。方法：诊断为癌症的青少年（14-20岁）/家庭二人组（N = 30）参加了一项双臂、随机对照试验。排除标准包括严重抑郁症和精神状态受损。通过满意度问卷测量可接受性。一般估计方程模型评估了FACE-TC对干预后3个月结果的影响，这些结果由儿童生活质量量表4.0通用核心量表、儿童生活质量量表4.0癌症特异性模块、贝克抑郁和焦虑量表、慢性疾病治疗功能评估精神幸福感量表- iv和预先指示完成度测量。结果：符合条件的家庭入组率为72%，三个疗程的出勤率为100%，干预后3个月的保留率为93%，数据完成率为100%，证明了可接受性。干预家庭认为FACE-TC是值得的（100%），而青少年的评价随着时间的推移而增加（65%-82%）。两组青少年的焦虑从基线到干预后3个月均显著下降（β = -5.6; p = 0.0212）。两组青少年均保持低抑郁症状评分和高生活质量评分。预先指示很容易在医疗记录中找到（100%的FACE-TC青少年与无对照）。肿瘤学家收到了电子版。FACE-TC青少年的总精神性得分（beta = 8.1; p = 0.0296）显著高于对照组。FACE-TC青少年赞同提出临终决定的最佳时间：19%在生病之前，19%在诊断时，首次生病或住院时没有，25%在死亡时，38%在以上所有情况下。结论：以家庭为中心的青少年癌症前期护理计划具有可行性和可接受性。勇敢的青少年愿意安全地参与高度结构化，深入的儿科提前护理计划对话。(C) 2014年青少年健康和医学学会。版权所有。
Purpose: To test the feasibility, acceptability and safety of a pediatric advance care planning intervention, Family-Centered Advance Care Planning for Teens With Cancer (FACE-TC).Methods: Adolescent (age 14-20years)/family dyads (N = 30) with a cancer diagnosis participated in a two-armed, randomized, controlled trial. Exclusion criteria included severe depression and impaired mental status. Acceptability was measured by the Satisfaction Questionnaire. General Estimating Equations models assessed the impact of FACE-TC on 3-month post-intervention outcomes as measured by the Pediatric Quality of Life Inventory 4.0 Generic Core Scale, the Pediatric Quality of Life Inventory 4.0 Cancer-Specific Module, the Beck Depression and Anxiety Inventories, the Spiritual Well-Being Scale of the Functional Assessment of Chronic Illness Therapy-IV, and advance directive completion.Results: Acceptability was demonstrated with enrollment of 72% of eligible families, 100% attendance at all three sessions, 93% retention at 3-month post-intervention, and 100% data completion. Intervention families rated FACE-TC worthwhile (100%), whereas adolescents' ratings increased over time (65%-82%). Adolescents' anxiety decreased significantly from baseline to 3 months post-intervention in both groups (beta = -5.6; p = .0212). Low depressive symptom scores and high quality of life scores were maintained by adolescents in both groups. Advance directives were located easily in medical records (100% of FACE-TC adolescents vs. no controls). Oncologists received electronic copies. Total Spirituality scores (beta = 8.1; p = .0296) were significantly higher among FACE-TC adolescents versus controls. The FACE-TC adolescents endorsed the best time to bring up end-of-life decisions: 19% before being sick, 19% at diagnosis, none when first ill or hospitalized, 25% when dying, and 38% for all of the above.Conclusions: Family-Centered Advance Care Planning for Teens With Cancer demonstrated feasibility and acceptability. Courageous adolescents willingly participated in highly structured, in-depth pediatric advance care planning conversations safely. (C) 2014 Society for Adolescent Health and Medicine. All rights reserved.