Enabling Advance Directive Completion: Feasibility of a New Nurse-Supported Advance Care Planning Intervention.
Michelle M Hilgeman, Constance R Uphold, Amber N Collins and 8 others
PMID 29969138WHAT IT FOUND
Veterans who received a nurse-led advance care planning session completed directives at a higher rate than those referred to usual social work support.
The nurse intervention took under an hour and was well received, but the study was too small to prove effectiveness.
Key findings
01Ninety-four percent of Veterans in the nurse-led intervention group completed an advance directive, compared to twenty-nine percent in the comparison group.
02The nurse-led session had a mean duration of forty-six minutes, while the comparison session took twenty-nine minutes.
03Participants in the nurse-led group were highly satisfied with the session, with a mean score of thirty-one out of thirty-two.
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 a small feasibility trial with only fifty participants, so it was not powered to determine if the intervention is truly more effective than usual care. The comparison group was not standard usual care; it was a modified version where study staff helped participants connect with doctors if they wanted medical information, which may have influenced completion rates. Several participants in the comparison group dropped out because they could not get appointments with their primary care providers within the study window. The groups were not perfectly balanced at baseline, with the nurse-led group having lower household income and a higher initial desire for information about life-sustaining treatments. Statistical tests were not performed on the primary outcome of advance directive completion rates, so the difference between groups is descriptive.
Declared interests
The authors disclosed no potential conflicts of interest. The work was funded by the United States Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, Nursing Research Initiative. The funding organization had no role in any part of the study.
The easy way to misread this
Do not conclude that the nurse-led intervention is proven to be more effective than social worker referrals. The study was a feasibility pilot with a small sample size, and no statistical tests were performed on the completion rates. The difference in completion rates may also be influenced by the modified nature of the comparison group and baseline differences in participants' desire for information.