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06:28
E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Facilitated Versus Patient-Directed Advance Care Planning Among Patients With Advanced Cancer: A Randomized Clinical
Yael Schenker1,2,3, Shane C Belin1,2, Tianxiu Wang1
1Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA.
JCO Oncology Practice
|March 19, 2025
Summary
Facilitated advance care planning (ACP) significantly improved patient engagement and advance directive completion compared to self-directed tools. Some cancer patients may require facilitator support for effective end-of-life care planning.
Area of Science:
- Oncology
- Palliative Care
- Health Services Research
Background:
- Advance care planning (ACP) is recommended for patient-centered end-of-life (EOL) care.
- Optimal methods for patient-facing ACP interventions remain unclear.
- Interventions vary in cost and complexity.
Purpose of the Study:
- To compare the effectiveness of two patient-facing ACP interventions.
- To evaluate facilitated ACP versus patient-directed ACP in patients with advanced solid tumors.
Main Methods:
- A single-blind, randomized comparative effectiveness trial.
- Adult patients with advanced solid tumors and their caregivers were recruited.
- Participants were randomized to facilitated ACP (nurse facilitators) or patient-directed ACP (written/web tools).
Main Results:
- Facilitated ACP showed higher patient engagement (4.34 vs 4.08) and advance directive completion (74.8% vs 60.6%) at 12 weeks.
- No significant differences were found in conversations about EOL wishes with family or physicians.
- All ACP behaviors increased significantly from baseline in both groups.
Conclusions:
- Facilitated ACP leads to greater engagement and advance directive completion than patient-directed materials.
- Some patients with advanced cancer benefit from additional facilitator support for ACP.
- Patient-directed ACP is effective but may be enhanced with facilitation.
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