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Patient-centered and efficacious advance care planning in cancer: the PEACe comparative effectiveness trial

以患者为中心且有效的癌症预先护理计划：PEACe 比较有效性试验

基本信息

批准号：
10569584
负责人：
Yael Schenker
金额：
$ 38.96万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-03-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10569584
关键词：
Academy Address Adopted Advance Care Planning Advance Directives Advanced Malignant Neoplasm American American Society of Clinical Oncology Anxiety Attention Behavior Therapy Cancer Center Cancer Patient Caregivers Caring Consensus Data Effectiveness Ensure Failure Family Family Caregiver Future Goals Health system Home Hospitalization Infrastructure International Intervention Intervention Trial Interview Investments Malignant Neoplasms Measures Medicine Methods Modeling Oncology Online Systems Outcome Patient Care Patient Outcomes Assessments Patient Preferences Patient-Centered Care Patients Persons Physicians Public Health Qualitative Evaluations Qualitative Research Quality of Care Reporting Research Research Methodology Resources Single-Blind Study System Time Training Writing anxiety symptoms cancer care care delivery chemotherapy clinical care comparative effectiveness comparative effectiveness trial compare effectiveness comparison intervention cost depressive symptoms design effectiveness evaluation end of life end of life care evidence base experience health care service utilization hospice environment implementation cost implementation evaluation improved innovation patient oriented peace post-traumatic stress preference primary outcome randomized trial relative effectiveness trial comparing

项目摘要

Abstract Summary: Failure to deliver care near the end of life that reflects the needs, values and preferences of patients with advanced cancer remains a key shortcoming of our cancer care delivery system. National organizations including the National Academy of Medicine and American Society of Clinical Oncology have called for increased attention to advance care planning (ACP) to improve patient-centered care near end of life. A critical barrier to progress in the field is a lack of evidence about the most effective and efficient ACP strategy to improve treatment decisions near end of life and ensure patients' wishes are honored. Two different patient-facing ACP interventions are widely used and known to be effective but entail sizeable differences in costs and complexity to deploy: (1) in-person discussions with trained facilitators and (2) web- based advance care planning using interactive videos. These approaches have never been compared directly; it is therefore unclear whether one form of ACP is more potent—and if so, for whom and under what circumstances. Understanding the relative effectiveness of in-person, facilitated versus web-based ACP is important because in-person ACP requires far more resources. This proposal is a single-blind, patient-level randomized trial to address this evidence gap, using mixed methods to compare the effectiveness of in-person, facilitated ACP vs web-based ACP among 400 patients with advanced cancer and their family caregivers. Aim 1 compares the effect of these approaches on patient and family caregiver outcomes (engagement in ACP—primary outcome; ACP discussions with family caregivers and physicians; advance directive (AD) completion; and caregiver symptoms of depression and anxiety). For patients who die during the study period, we will use validated, caregiver-reported measures to compare perceived quality of EOL care, patients' EOL goal attainment, and bereaved caregiver symptoms of depression, anxiety and post-traumatic stress. Aim 2 assesses implementation costs of each intervention and effects on healthcare utilization at end of life. Aim 3 identifies contexts and mechanisms influencing the effectiveness of each approach. This trial will have a high impact because it will provide new and much-needed empirical evidence about two patient-facing ACP approaches that successfully overcome limitations of traditional written advance directives but entail very different investments of time and resources. It is innovative in using mixed methods to evaluate not only the comparative effectiveness of these approaches, but also for whom, how and in what circumstances they are effective. It is feasible because it builds on extensive infrastructure developed by an accomplished research team with experience conducting behavioral intervention trials and qualitative research in ACP and oncology.

摘要总结: