A Randomized Controlled Trial of Strategies to Improve Family Members' Preparedness for Surrogate Decision-Making.
Michael J Green, Lauren J Van Scoy, Andrew J Foy and 10 others
PMID 29186982WHAT IT FOUND
Family members' confidence in surrogate decision-making was already high and did not improve clearly with a comprehensive online planning tool, but their accuracy in predicting patients' wishes improved compared with basic forms, and having family join did not improve accuracy.
Key findings
01Family members of patients who used MYWK had higher overall concordance with patients' treatment choices than those whose patients used basic ACP materials (85.2% vs 79.7%).
02Planning together with family members did not improve overall concordance or individual treatment concordance compared with patients planning alone.
03Family members' self-efficacy scores were high at baseline (90.2 with MYWK and 90.1 with basic ACP), and the increase was significant only in the basic ACP group (mean change 3.2).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Recruiting severely ill patients and their family members was difficult. The refusal rate was 50% and the exclusion rate was 38%, so the analysed group may not represent all patients with advanced illness. Decliners who completed surveys were less educated and less confident in their computer skills than participants. Participants were generally well educated and had prior experience with advance care planning. Family members' confidence scores were already above 90 on a 0 to 100 scale at baseline. This ceiling may have limited further gains. Concordance was measured only after the intervention. The study cannot rule out that the groups differed before planning. Participants knew whether they were planning alone or together. Researchers were not formally blinded when gathering data.
The easy way to misread this
Do not conclude that involving family members in advance care planning makes them better prepared. The Together and Alone groups did not differ in concordance, and family members' confidence was already high before planning.