Feasibility and acceptability of a decision aid designed for people facing advanced or terminal illness: a pilot randomized trial

Abstract

Background Patients nearing the end of their lives face an array of difficult decisions.

Shared decision making and the use of a patient decision aid in advanced serious illness: provider and patient perspectives

“…Our prior study suggested that inpatients and decision‐makers wanted this PtDA earlier. Our primary care patients validated the main thematic findings from that study stating that the PtDA was highly acceptable and should be given early in the course of illness. What we know now is that near the end of life is likely too late .…”

“…Our primary care patients validated the main thematic findings from that study stating that the PtDA was highly acceptable and should be given early in the course of illness. What we know now is that near the end of life is likely too late . However, whether it should be given during a state of stability by a PCP, or during the time of diagnosis by a specialist or hospital team is unanswered.…”

“…Providers’ opinions varied based on their opinions about palliative care, and this highlights that further work is needed to explore the tensions between provider personal and professional goals and shared decision‐making roles with patients and families. Reach and effectiveness of the PtDA were assessed in a prior pilot randomized controlled study of inpatient palliative care patients and their decision‐makers . Our prior study suggested that inpatients and decision‐makers wanted this PtDA earlier.…”

“…The framework helps understand pragmatic elements of recruitment and participation in an intervention (Reach), the impact of the intervention on outcomes meaningful to patients (Effectiveness), likelihood of staff or setting perceived feasibility and uptake (Adoption), process modifications or adaptations that would be needed (Implementation) and the extent to which an intervention can become part of routine practice (Maintenance). The first two components of the evaluation framework reach and effectiveness (RE) of the PtDA were assessed among patients and their decision‐makers from the inpatient palliative care service at University of Colorado Hospital through a pilot randomized controlled trial (RCT) . Reach was quantified as the proportion and representativeness of the target population of individuals willing to participate, while the effectiveness was measured by impact outcomes of decision conflict and knowledge …”

“…The first two components of the evaluation framework reach and effectiveness (RE) of the PtDA were assessed among patients and their decision‐makers from the inpatient palliative care service at University of Colorado Hospital through a pilot randomized controlled trial (RCT) . Reach was quantified as the proportion and representativeness of the target population of individuals willing to participate, while the effectiveness was measured by impact outcomes of decision conflict and knowledge …”