Collaborative advance care planning in advanced cancer patients: col-ACP –study – study protocol of a randomised controlled trial

Abstract

Background: To assure patient-centred end-of-life care, palliative interventions need to account for patients' preferences. Advance care planning (ACP) is a structured approach that allows patients, relatives and physicians to discuss end-of-life decisions. Although ACP can improve several patient related outcomes, the implementation of ACP remains difficult. The col-ACP-study (collaborative advance care planning) will investigate a new ACP procedure (col-ACP-intervention (German: Hand-in-Hand Intervention)) in palliative cancer patients and their relatives that addresses individual values and targets barriers of communication before an ACP process. Methods: In a randomised controlled trial, 270 cancer patients without curative treatment options and their relatives will receive either 1) col-ACP 2) a supportive intervention (active control group) or 3) standard medical care (TAU). col-ACP comprises two steps: a) addressing various barriers of patients and relatives that discourage them from discussing end-of-life issues followed by b) a regular, structured ACP procedure. The col-ACP-intervention consists of 6 sessions. Primary endpoint is the patients' quality of life 16 weeks after randomisation. Secondary endpoints include measurements of distress; depression; communication barriers; caregivers' quality of life; existence of ACP or advance directives; the consistence of end of life care; and others. Patients will be followed up for 13 months. Multivariate analyses will be carried out. Qualitative evaluation of the intervention will be conducted. Discussion: Augmentation of a regular ACP program by a structured psycho-oncological intervention is an innovative approach to target barriers of communication about end-of-life issues. Study findings will help to understand the value of such a combined intervention in palliative care.

Barriers to Advance Care Planning in Older Adults With Dementia, Their Families and Healthcare Professionals: An Umbrella Review of Qualitative Evidence

“…Such findings also apply to other groups of people, such as those with chronic obstructive pulmonary disease (Meehan et al, 2020), cancer (Seifart et al, 2020), and the general population (Hemsley et al, 2019;Jimenez et al, 2018). Collaboration among stakeholders is vital because of the difficulty of assessing and fulfilling the preferences and wishes of persons with dementia.…”

‘It was like taking an inner bath’: A qualitative evaluation of a collaborative advance care planning-approach

“…An extensive research protocol comprising detailed information on study design, participant characteristics, recruitment sites and methods, the intervention, data collection process and analysis has been published in an open access format. 25 The col-ACP-study was registered at ClinicalTrials.gov (NCT03387436).…”

“…To improve access and quality of advance care planning the intervention targeted psychosocial barriers of advanced cancer patients and informal caregivers towards end-of-life discussions applying dignity-based and cognitive behaviour-based interventions preceding a standardised advance care planning-process. 24,25 This qualitative research adds to the literature by exploring cancer patients’ and carers’ perceptions of a novel collaborative advance care planning-model evaluating combined effects focusing on communication and relationship dynamics.…”

The development of a guidance document for interprofessional collaborative advance care planning in dementia care

“…ACP is considered as a shared responsibility of persons with dementia 5 , family members 25 and the interprofessioneal team 26, 27 . For example, physicians 28, 29 , nurses 28, 30-32 , psychologists 33 , social workers 28, 34 , and priests 28, 35 . To date, a few guidances or practical tools on how to conduct ACP conversations in dementia care have been documented 36-38 .…”