Evaluation of a Novel Hospice-Specific Patient Decision Aid.
Channing E Tate, Gwendolyn Mami, Monica McNulty and 6 others
PMID 37477279WHAT IT FOUND
A hospice decision aid did not improve older adults' hospice knowledge or attitudes more than controls at 1 month, but it did increase confidence in making medical decisions.
The aid was rated clear and balanced.
Key findings
01At 1 month, hospice knowledge and favorable opinions of hospice did not differ between the decision aid group and the control group.
02Decision self-efficacy increased more in the decision aid group than in the control group (8.04 points versus 2.90 points; the between-group difference was significant, .027).
03Most aid users rated it helpful: 96.4% found the explanation of hospice good or excellent, 78.7% found it balanced, and 93.5% found its length appropriate.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a pilot study, not a definitive trial, and the authors combined two cohorts with different recruitment methods and randomization ratios. Participants were healthy adults aged 65 or older, not people already facing imminent end-of-life decisions, so it does not show what happens when hospice choices are urgent. The sample was highly educated and already had high hospice knowledge at baseline, so there was little room for improvement. Hospice knowledge and attitudes improved in both groups, and controls received no aid until after the 1-month visit, so the study cannot show that the aid alone caused those within-group improvements. The positive self-efficacy finding was driven by the combined sample and was not significant in the African American community cohort. Outcomes were self-report, and the authors note that a quantitative hospice knowledge survey may not capture nuanced understanding.
Declared interests
The supplied text does not provide a funding or conflict-of-interest statement.
The easy way to misread this
Do not conclude that the decision aid improves hospice knowledge or attitudes. Those outcomes did not differ from controls. Do not apply the positive confidence finding to patients facing urgent hospice decisions, because the participants were healthy older adults and the study was a pilot.