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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