Collaborative advance care planning in palliative care: a randomised controlled trial

Area of Science:

• Oncology
• Palliative Care
• Psycho-oncology

Background:

• Advance care planning (ACP) is crucial for end-of-life (EOL) care in cancer patients.
• Psychological barriers often impede access to and effectiveness of ACP.
• A novel model, collaborative ACP (col-ACP), integrates psycho-oncology with structured ACP.

Purpose of the Study:

• To evaluate the effectiveness and efficiency of the col-ACP model in palliative cancer patients.
• To assess the impact of col-ACP on EOL care concordance and patient preparedness.
• To determine if col-ACP influences patient and caregiver quality of life, stress, depression, or peace.

Main Methods:

• A randomized controlled trial involving 277 palliative cancer patients and their relatives.
• Three arms: col-ACP (psycho-oncological support + standardized ACP), supportive intervention (active control), and standard medical care.
• Outcomes included completion of advance directives, healthcare proxies, and patient-reported preparedness and confidence in communication of wishes.

Main Results:

• Patients in the col-ACP group showed significantly higher completion rates for advance directives (p<0.01) and healthcare proxies (p<0.01).
• col-ACP improved patients' sense of preparedness for future treatment (p<0.01) and confidence that their wishes were known (p=0.03).
• No significant differences were observed in quality of life, stress, depression, or peace between groups for patients or caregivers.

Conclusions:

• The col-ACP model effectively improves readiness for and access to ACP, leading to more consistent EOL care.
• While not directly impacting quality of life, col-ACP empowers patients in treatment planning and autonomous decision-making.
• Enhanced integration between psycho-oncological and ACP services is recommended for improved patient support.