Impact of a Formal Advance Care Planning Program on End-of-Life Care for Patients With Heart Failure: Results From a Randomized Controlled Trial.
J Card Fail
; 26(7): 594-598, 2020 Jul.
Article
in En
| MEDLINE
| ID: mdl-31991216
ABSTRACT
BACKGROUND:
There is no evidence on effectiveness of advance care planning (ACP) among patients with heart failure (HF). We examined the effect of an ACP program in facilitating end of life (EOL) care consistent with the preferences of patients with HF (primary aim), and on their decisional conflict, discussion with surrogates, illness understanding, anxiety, depression, and quality of life (secondary aims).METHODS:
We randomized 282 patients with HF to receive ACP (n=93) or usual care (control arm, n=189). Primary outcomes were assessed among deceased (n=89) and secondary outcomes from baseline and 6 follow-ups conducted every 4 months.RESULTS:
Deceased patients in the ACP arm were no more likely than those in control arm to have wishes followed for EOL treatments (ACP 35%, Control 44%; P= .47), or place of death (ACP 52%, Control 51%; Pâ¯=â¯.1.00). A higher proportion in the ACP arm had wishes followed for cardiopulmonary resuscitation (ACP 83%, Control 62%; Pâ¯=â¯.12). At first follow-up, patients with ACP had lower decisional conflict (ß = -10.8, P< .01) and were more likely to discuss preferences with surrogates (ßâ¯=â¯1.3, Pâ¯=â¯.04). ACP did not influence other outcomes.CONCLUSION:
This trial did not confirm that our ACP program was effective in facilitating EOL care consistent with patient preferences. The program led to short-term improvements in the decision-making.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Terminal Care
/
Hospice Care
/
Advance Care Planning
/
Heart Failure
Type of study:
Clinical_trials
/
Prognostic_studies
Aspects:
Patient_preference
Limits:
Humans
Language:
En
Journal:
J Card Fail
Journal subject:
CARDIOLOGIA
Year:
2020
Document type:
Article
Publication country:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA