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Clinical Question
Does advance care planning lead to increased completion of advance directives and selection of surrogate decision makers among frail elders?
Bottom line
In this study, an intensive advance care planning intervention dramatically increased the completion of advance directives and the identification of surrogate decision makers. 2b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Foundation
Setting: Other
Synopsis
These researchers conducted a cluster randomized trial of facilitated advance care planning education or usual care among modestly frail elders living in residential care homes or receiving home care nearby. The education intervention included trained facilitators and educational materials and tools intended to identify the patients' goals, values, and preferences regarding their health care and to assist in identifying a surrogate decision maker in the event of noncompetence. In addition to assigning an "activation score" (not all that important), the researchers assessed whether the patient had documented their advance care preferences and had selected a surrogate decision maker. The researchers included 16 clusters that contributed 201 patients (between 1 and 53 patients per cluster). The patients in each group were in their mid-80s and, unsurprisingly, most were female. The intervention patients were more likely to receive home-based care (61%) and to have completed high school (65%) than the control patients (49% and 40%, respectively). At the end of 1 year, 93% of the intervention group had completed an advance directive compared with 34% of control patients (number needed to treat [NNT] = 2; 95% CI 2 - 3). Additionally, 94% of the intervention participants had identified a surrogate decision maker compared with 67% of the control patients (NNT= 4; 3 - 6). Unfortunately, the consultation sessions took an average of 2 hours, including travel time, to complete.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
2 heures pour faire la discussion, et le voyagement n'est pas un inconvénient mais un placement pour le bien-être du patient et une économie affective pour les proches sans compter une meilleur allocation des ressources pour le système de santé. Cette étude prouve que nos instances gouvernementales se doit de mettre en place un programme systématique.
good poem
Excellent