Decision support intervention (Plan Well Guide) for patients and their substitute decision-makers to improve engagement in advance care planning: protocol for a randomised trial

Abstract

ObjectiveThe purpose of this randomised trial is to evaluate the efficacy of a decision support intervention for serious illness decisions (the Plan Well Guide decision aid;www.PlanWellguide.com) in increasing the engagement of substitute decision-makers (SDMs) in the patient’s advance care planning process (ie, ‘ACP engagement’), specifically the SDM’s confidence and readiness for the role in the future.Methods and analysisThis study is a parallel group randomised controlled trial. We aim to enrol 90 participant dyads: patients aged 65 years and older attending outpatient healthcare settings and with indicators they would be at high risk of needing future medical decisions and their SDM. The intervention is the Plan Well Guide decision aid, administered to the patient by a facilitator, with the SDM present. The primary endpoint is change after 3 months in the SDM’s ACP engagement using a validated measure of behavioural change (SDM’s knowledge, contemplation, self-efficacy and readiness) to enact the role. The secondary endpoints are (1) ACP engagement of the patient measured by a validated survey; (2) change in SDM decisional conflict regarding involvement in future decision-making and (3) postintervention patient decisional conflict regarding preference for life-sustaining treatments. Primary and secondary continuous outcomes will be analysed using the linear regression. The mean difference and 95% CIs will be reported.Ethics and disseminationApproval was received August 2017 (2017-3714-GRA) from the Hamilton Integrated Research Ethics Board. We plan to disseminate trial results in peer-reviewed journals, at national and international conferences, and via our web-based knowledge translation platforms.Trial registration numberNCT03239639; Pre-results.

Advance Care Planning Engagement Among Family Members of Community-Dwelling Elderly Patients With Chronic Diseases in China

“…Future research can compare patients' ACP engagement to see any inconsistency in the behavior change stage when they engaged in ACP. 22,24 Another line of research could be conducting a collaborative ACP intervention among the patients and their family members to reduce family conflicts, 18,27 promote engagement in the ACP simultaneously and effectively, to achieve a greater effect.…”

Evaluation of a French adaptation of a community-based advance serious illness planning decision aid

“…PWG was evaluated in two randomized trials. In the first one, conducted in an outpatient setting in Ontario, exposure to PWG increased the engagement of supportive decision-makers in ACP [ 18 ]. In the second one, conducted in three primary care practices in Alberta, the PWG reduced patient decisional conflict.…”

Advance care planning; we need to do it more, but it needs to be done differently

“…This too may contribute to the attitudes of acute care physicians that ACP is not helpful or indicated. The way to advance and move forward involves more robust, reliable, and useful tools that help patients establish their authentic values and transparently connects those values to possible treatment options made in the context of uncertainty [10]. Unfortunately, in the study by Knight and colleagues the quality or utility of existing advance care plans is not commented or investigated.…”