To examine the effectiveness of an advance care planning (ACP) intervention in facilitating concordance between cancer patients’ preferred and life-sustaining treatments (LSTs) received in the last month and in improving quality of life (QOL), anxiety symptoms, and depressive symptoms over the dying process.
Terminally ill cancer patients (N = 460) were randomly assigned 1:1 to the experimental and control arms. Data were obtained from 430 participants who died through December 2017. The experimental arm received an individualized, interactive ACP intervention tailored to participants’ readiness to engage in ACP. The control arm received a sham intervention of education on symptom management. Group allocation was concealed, data collectors were blinded, and treatment fidelity was ensured. Outcome measures included concordance of preferences for and receipt of six LSTs, QOL (McGill Quality of Life Questionnaire scores), as well as anxiety and depressive symptoms (Hospital Anxiety and Depression Scale scores). Intervention effectiveness was evaluated by intention-to-treat analysis.
Concordance between LST preferences and LSTs received were 58.2-77.5% and 59.0-75.7% for the experimental and control arms, respectively. Between-arm differences in concordance between the six preferred and received LSTs were not significantly (odds ratios [95% CI]: 0.966 [0.653, 1.428]-1.107 [0.690, 1.775]). Participants in the experimental arm had significantly lower anxiety (β [95% CI]=-0.583 [-0.977, -0.189], p = 0.004) and depressive (β [95% CI]=-0.533 [-1.036, -0.030], p = 0.038) symptoms than those in the control arm, but QOL did not differ.
Our individualized, and interactive ACP intervention facilitated participants’ psychological adjustment to the end-of-life (EOL)-care decision-making process, but did not improve their QOL nor facilitate EOL care that honored their wishes before death. Our findings can ensure clinicians that ACP intervention is not detrimental to patients’ psychological well-being, but improves it at EOL.
Clinical trial identification
Legal entity responsible for the study
Chang Gung University, School of Nursing.
National Health Research Institutes in Taiwan.
All authors have declared no conflicts of interest.