Advance Care Planning-Complex and Working: Longitudinal Trajectory of Congruence in End-of-Life Treatment Preferences: An RCT.
Maureen E Lyon, Sarah Caceres, Rachel K Scott and 6 others
PMID 33530701WHAT IT FOUND
Advance care planning conversations with patients and their surrogates increased agreement on end-of-life treatment preferences over 18 months.
Surrogates felt more prepared, though agreement declined over follow-up.
Key findings
01The advance care planning group was more likely than the control group to be in the high congruence class (52% versus 26%; odds ratio 7.10).
02Surrogates in the advance care planning group reported greater preparedness and confidence, including about 3 times the odds of feeling prepared for the future versus controls.
03Agreement probabilities declined over follow-up, but the high congruence class still had a higher probability of perfect agreement at each time point.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in hospital-based HIV clinics in one urban location, so it may not fit other settings. Only 33% of potentially eligible dyads enrolled, and many declined because of time, not wanting research or not wanting to talk about advance care planning. Patients and surrogates knew which group they were in, so their reports of preparedness could be influenced by expectations. The congruence analysis used 206 dyads (409 participants), while 223 dyads (446 participants) were randomized. Many interested patients could not identify a surrogate (44%), so the results apply mainly to patients who have a surrogate. Facilitators were trained graduate students, psychologists, social workers or nurses, so the effect may depend on skilled delivery.
The easy way to misread this
Do not conclude that advance care planning guaranteed patients received the care they wanted. This trial measured agreement between patient and surrogate on hypothetical end-of-life choices, not actual end-of-life treatment.