A Randomized Controlled Trial of a Cardiopulmonary Resuscitation Video in Advance Care Planning for Progressive Pancreas and Hepatobiliary Cancer Patients
A Randomized Controlled Trial of a Cardiopulmonary Resuscitation Video in Advance Care Planning for Progressive Pancreas and Hepatobiliary Cancer Patients
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DOI：
10.1089/jpm.2012.0524
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发表时间：
2013-06-01
影响因子：
2.8
通讯作者：
O'Reilly, Eileen M.
中科院分区：
文献类型：
--
作者：
Epstein, Andrew S.;Volandes, Angelo E.;O'Reilly, Eileen M.
背景资料：心肺复苏术（CPR）是一个重要的预先指导（AD）的主题，在患者进行性cancer;然而，这样的讨论是challenging.Objective：本研究探讨是否视频教育信息心肺复苏术产生更广泛的提前护理计划（ACP）discourse.Methods：患者进行性胰腺癌或肝胆癌被随机分配到教育CPR视频或类似的CPR叙事。主要终点是两组间试验后1个月ACP记录的差异。次要终点包括研究印象;干预前和干预后的知识和偏好心肺复苏术和机械通气;和纵向患者outcomes.Results：五十六例受试者同意和分析。视频组的ACP记录率（正式AD或记录的讨论）为40%（12/30），而叙述组为15%（4/26），OR=3.6 [95% CI：0.9-18.0]，p = 0.07。两组的干预后知识均较高。测试后，视频组对心肺复苏术的偏好发生了变化，但叙事组没有变化。两组中对机械通气的偏好都没有变化。两组中的大多数受试者都报告说，这些信息对讨论有帮助，而且讨论起来很舒服，他们向其他人推荐了这些信息。更多的死亡发生在视频手臂相比，叙事手臂，更多的受试者死于临终关怀设置在video arm.Conclusions：这个试点随机试验解决下游ACP视频与叙事决策工具的影响表现出一种趋势，对更多的ACP文件在视频科目。这种趋势以及其他视频效果是正在进行的研究的主题。
Background: Cardiopulmonary resuscitation (CPR) is an important advance directive (AD) topic in patients with progressive cancer; however such discussions are challenging.Objective: This study investigates whether video educational information about CPR engenders broader advance care planning (ACP) discourse.Methods: Patients with progressive pancreas or hepatobiliary cancer were randomized to an educational CPR video or a similar CPR narrative. The primary end-point was the difference in ACP documentation one month posttest between arms. Secondary end-points included study impressions; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation; and longitudinal patient outcomes.Results: Fifty-six subjects were consented and analyzed. Rates of ACP documentation (either formal ADs or documented discussions) were 40% in the video arm (12/30) compared to 15% in the narrative arm (4/26), OR=3.6 [95% CI: 0.9-18.0], p = 0.07. Post-intervention knowledge was higher in both arms. Posttest, preferences for CPR had changed in the video arm but not in the narrative arm. Preferences regarding mechanical ventilation did not change in either arm. The majority of subjects in both arms reported the information as helpful and comfortable to discuss, and they recommended it to others. More deaths occurred in the video arm compared to the narrative arm, and more subjects died in hospice settings in the video arm.Conclusions: This pilot randomized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects. This trend, as well as other video effects, is the subject of ongoing study.