Improving a Full Range of Advance Care Planning Behavior Change and Action Domains: The PREPARE Randomized Trial

Advance care planning (ACP) engagement includes a wide range of behaviors and actions related to discussions and documentation, yet few ACP intervention studies measure the full process. The objective of the study was to compare the effects of an easy-to-read advance directive (AD) versus an ACP web...

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Bibliographic Details
Published in:Journal of pain and symptom management 2018-10, Vol.56 (4), p.575-581.e7
Main Authors: Lum, Hillary D., Barnes, Deborah E., Katen, Mary T., Shi, Ying, Boscardin, John, Sudore, Rebecca L.
Format: Article
Language:English
Subjects:
Action
Advance Care Planning
advance directive
Advance directives
Aged
Behavior change
Behavior modification
Care plans
communication
Death & dying
decision aid
Decision makers
Evidence-based medicine
Female
Flexibility
Health Communication
Health Knowledge, Attitudes, Practice
Humans
Internet
Intervention
Linear analysis
Long term health care
Male
Medical treatment
Patient Participation
Patients
Primary care
Primary Health Care
Quality Improvement
Quality of life
Reading
Self-efficacy
Treatment Outcome
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Summary:Advance care planning (ACP) engagement includes a wide range of behaviors and actions related to discussions and documentation, yet few ACP intervention studies measure the full process. The objective of the study was to compare the effects of an easy-to-read advance directive (AD) versus an ACP web site plus the AD (PREPARE + AD) on Behavior Change Processes and Actions, including discussions and documentation. Secondary data were from a completed ACP trial. Participants were primary care patients, ≥60 years old, with two comorbidities. We used the validated ACP Engagement Survey to examine six-month change in subscales measuring Behavior Change Processes (knowledge, contemplation, self-efficacy, readiness) and Actions (decision makers, quality of life, flexibility for decision makers, asking clinicians questions), specifically related to discussions and documentation. We used adjusted mixed-effects linear models to compare mean change and engagement over time. Compared to the AD-only, PREPARE + AD resulted in greater increases in all Behavior Change Processes subscales and Actions related to decision makers, quality of life, and flexibility (all P-values ≤0.005). Both interventions significantly increased the proportion of participants who engaged in ACP discussions (PREPARE + AD, 99.5%; AD-only, 93.3%) and documentation (PREPARE + AD, 99.5%; AD-only, 90.4%), with greater increases for PREPARE + AD (all P-values
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2018.06.007