Development and pilot of an advance care planning website for women with ovarian cancer: a randomized controlled trial.
Development and pilot of an advance care planning website for women with ovarian cancer: a randomized controlled trial.
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DOI：
10.1016/j.ygyno.2013.08.017
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发表时间：
2013-11
影响因子：
4.7
通讯作者：
Geller MA
中科院分区：
文献类型：
--
作者：
Vogel RI;Petzel SV;Cragg J;McClellan M;Chan D;Dickson E;Jacko JA;Sainfort F;Geller MA
很少有工具可以帮助癌症患者和医生讨论生活质量和生命终结。我们的目标是开发一个基于网络的工具，以促进卵巢癌妇女的提前护理计划。患有卵巢癌的妇女、她们的家人、临床医生和研究人员会面，确定改善癌症治疗的方法。创建了一个原型网站，以解决预先护理计划，重点是预先医疗保健指令（AHD）和姑息治疗咨询。从妇科肿瘤诊所招募患者进行随机对照试验。主要结果包括完成AHD和姑息治疗咨询。在研究结束时，53名患有卵巢癌的女性被纳入研究，其中35人完成了研究。入组时平均年龄57.9±9.5岁；大多数为新诊断或首次复发。干预组与对照组在AHD完成情况（p = 0.220）和姑息治疗咨询情况（p = 0.440）方面均无统计学差异。然而，干预组的妇女表现出对AHD和姑息治疗的决策倾向，决策冲突减少的迹象。与对照组相比，被分配到干预组的女性对信息的数量（p = 0.054）和质量（p = 0.119）非常满意，并且当她们访问网站时，使用时间更长（p = 0.049）。由于一些与患者相关的障碍和设计障碍，网站的总体使用率低于预期。为卵巢癌妇女提供信息和决策支持的网站是可行的。越来越频繁的网站使用需要未来的研究。
Few available tools facilitate cancer patients and physicians' discussions of quality of life and end-of-life. Our objective was to develop a web-based tool to promote advance care planning for women with ovarian cancer. Women with ovarian cancer, their families, clinicians and researchers met to identify ways to improve cancer care. A prototype website was created to address advance care planning, focusing on advance healthcare directives (AHD) and palliative care consultation. Patients were recruited from a gynecologic oncology clinic for a pilot randomized controlled trial. Primary outcomes included completion of an AHD and palliative care consultation. At study completion, 53 women with ovarian cancer were enrolled and 35 completed the study. The mean age at enrollment was 57.9 ± 9.5 years; most were newly diagnosed or at first recurrence. There were no statistical differences in completion of AHD (p = 0.220) or palliative care consultation (p = 0.440) between intervention and control groups. However, women in the intervention group showed evidence of moving toward decision making regarding AHD and palliative care and lower decisional conflict. Women assigned to the intervention, compared to control website, were highly satisfied with the amount (p = 0.054) and quality (p = 0.119) of information and when they accessed the website, used it longer (p = 0.049). Overall website use was lower than expected, resulting from several patient-related and design barriers. A website providing information and decisional support for women with ovarian cancer is feasible. Increasing frequency of website use requires future research.