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Culturally Adapted RN-MD Collaborative SICP-Based ACP: Feasibility RCT in Advanced Cancer Patients.

Sayaka Takenouchi1, Yu Uneno2, Shigemi Matsumoto3

  • 1Human Health Sciences, Graduate School of Medicine, Kyoto University (S.T., A.C., T.K., S.T.), Kyoto, Japan.

Journal of Pain and Symptom Management
|September 5, 2024
PubMed
Summary

Culturally adapted advance care planning improved spiritual well-being and quality of life for advanced cancer patients preferring family involvement. Though completion rates were lower than targeted, the intervention showed promise for future trials.

Keywords:
Advance care planningadvanced cancercultural adaptationnurse-physician collaborationshared decision-making

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Area of Science:

  • Oncology
  • Palliative Care
  • Health Services Research

Background:

  • Cultural adaptation is crucial for autonomy-focused programs like the Serious Illness Care Program (SICP).
  • Family-involved decision-making is highly valued by certain patient populations.
  • Optimizing interventions requires tailoring to specific cultural contexts and preferences.

Purpose of the Study:

  • To assess the feasibility and efficacy of a culturally adapted SICP-based Advance Care Planning (ACP) intervention.
  • To evaluate a nurse-physician collaborative ACP intervention for advanced cancer patients preferring family involvement.
  • To tailor ACP to cultural values and enhance patient-centered care.

Main Methods:

  • Oncology nurses delivered a culturally adapted SICP-based ACP intervention, emphasizing trust-building and family involvement.
  • Patients within six weeks of starting first-line palliative chemotherapy were included.
  • Primary endpoints included a 70% completion rate and spiritual well-being (FACIT-Sp); secondary endpoints assessed anxiety, depression, quality of life (QOL), and ACP progress.

Main Results:

  • The intervention group showed a significant improvement in spiritual well-being (P = 0.009).
  • Enhanced quality of life (QOL) and advance care planning (ACP) progress were observed in the intervention group.
  • The six-month completion rate was 67.2%, falling short of the 70% target.

Conclusions:

  • The culturally adapted ACP intervention improved spiritual well-being, QOL, and ACP progress despite not meeting the completion target.
  • Findings suggest refining the intervention manual to enhance feasibility.
  • Further research with an efficacy-focused randomized controlled trial is warranted.