A randomized trial of acceptability and effects of values-based advance care planning in outpatient oncology: Person-Centered Oncologic Care and Choices Journal Article


Authors: Epstein, A. S.; O'Reilly, E. M.; Shuk, E.; Romano, D.; Li, Y.; Breitbart, W.; Volandes, A. E.
Article Title: A randomized trial of acceptability and effects of values-based advance care planning in outpatient oncology: Person-Centered Oncologic Care and Choices
Abstract: Context: No standard advance care planning (ACP) process exists in oncology. We previously developed and validated the values questions for Person-Centered Oncologic Care and Choices (P-COCC), a novel ACP intervention combining a patient values interview with an informational care goals video. Objectives: To pilot-study acceptability and, using randomization, explore potential utility of P-COCC. Methods: Eligibility included patients with advanced gastrointestinal cancer cared for at a comprehensive cancer center. Participants were randomized 2:2:1 to P-COCC vs. video alone vs. usual care, respectively. Validated assessments of well-being and decisional conflict were completed. Participants in the P-COCC arm also completed three Likert scales (was the intervention helpful, comfortable, and recommended to others); a positive score of at least 1 of 3 indicated acceptability. Results: Patients were screened from 9/2014 to 11/2016; 151 were consented and randomized, 99 whom completed study measures (most common attrition reason: disease progression or death). The primary aim was met: Among 33 participants, P-COCC was acceptable to 32 (97%, 95% CI: 0.84–0.99, P < 0.001). Mean distress scores (0–10) increased (0.43) in the P-COCC arm but decreased in the video-alone (−0.04) and usual-care (−0.21) arms (P = 0.03 and 0.04, P-COCC vs. video-alone and usual-care arms, respectively). There were no significant pre-post change scores on other measures of well-being (e.g., anxiety, depression, stress) or intergroup differences in decisional conflict. Conclusion: Our values-based ACP paradigm is acceptable but may increase distress in cancer outpatients. Further studies are investigating the underpinnings of these effects and ways to best support cancer patients in ACP. © 2018 American Academy of Hospice and Palliative Medicine
Keywords: patient participation; communication; goals; advance care planning; cancer
Journal Title: Journal of Pain and Symptom Management
Volume: 56
Issue: 2
ISSN: 0885-3924
Publisher: Elsevier Inc.  
Date Published: 2018-08-01
Start Page: 169
End Page: 177.e1
Language: English
DOI: 10.1016/j.jpainsymman.2018.04.009
PROVIDER: scopus
PMCID: PMC6050128
PUBMED: 29729347
DOI/URL:
Notes: Article -- Export Date: 1 August 2018 -- Source: Scopus
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MSK Authors
  1. Yuelin Li
    136 Li
  2. William S Breitbart
    335 Breitbart
  3. Andrew Saul Epstein
    68 Epstein
  4. Eileen O'Reilly
    300 O'Reilly
  5. Elyse Shuk
    48 Shuk
  6. Danielle Rae Romano
    3 Romano