2884 - Randomized clinical trial of an individualized intervention promotes cancer patients’ prognostic awareness and reduces CPR received in the last month

Background

Half of advanced cancer patients do not have accurate prognostic awareness (PA). However, few randomized clinical trials (RCTs) have focused on facilitating these patients’ PA to reduce their life-sustaining treatments (LSTs) at end of life.

Methods

A blinded RCT was conducted for terminally ill cancer patients with internal validity enhanced by concealing arm allocation, blinding participants and data collectors, and ensuring treatment fidelity. The experimental-arm received an interactive intervention tailored to their readiness for prognostic information. The control-arm received a sham symptom-management educational treatment. Effectiveness of the intervention in facilitating accurate PA and reducing LSTs received was evaluated by intention-to-treat analysis using multivariate logistic regression, specifically by modeling “arm by time proximity to death” with the generalized estimating equation and “arm by accurate PA” interactions, respectively.

Results

Participants (N = 460) were randomly assigned 1:1 to experimental and control arms, each with 215 participants in the final sample. With reference to 151-180 days before death, the experimental-arm had significantly higher odds of accurate PA than the control-arm 61-90, 91-120, and 121-150 days before death (AOR [95% CI]: 1.94 [1.10-3.40], 1.89 [1.06-3.36], and 1.98 [1.19-3.28], respectively) but not 1-60 days before death. Experimental-arm participants with accurate PA were significantly less likely than control-arm participants without accurate PA to receive cardiopulmonary resuscitation (CPR) (0.16 [0.03-0.73]), but not less likely to receive other LSTs (including intensive care unit care and mechanical ventilation) in their last month.

Conclusions

Our intervention facilitated participants’ accurate PA early in their terminal-illness trajectory, thereby reducing their risk of receiving CPR in their last month and avoiding suffering from futile LSTs.

Clinical trial identification

NCT01912846.

Legal entity responsible for the study

Chang Gung University.

Funding

National Health Research Institutes (NHRI-EX106-10208PI), Ministry of Science and Technology (MOST 104-2314-B-182-027-MY3), Chang Gung Memorial Hospital (BMRP888).

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.