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Advance Care Planning in Frail Older Adults: A Cluster Randomized Controlled Trial
Author(s) -
Overbeek Anouk,
Korfage Ida J.,
Jabbarian Lea J.,
Billekens Pascalle,
Hammes Bernard J.,
Polinder Suzanne,
Severijnen Johan,
Swart Siebe J.,
Witkamp Frederika E.,
van der Heide Agnes,
Rietjens Judith A.C.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15333
Subject(s) - medicine , advance care planning , randomized controlled trial , quality of life (healthcare) , intervention (counseling) , cluster randomised controlled trial , cluster (spacecraft) , demographics , decision maker , physical therapy , gerontology , directive , affect (linguistics) , psychological intervention , family medicine , palliative care , nursing , demography , psychology , management science , sociology , computer science , programming language , economics , communication
Objectives To determine the effectiveness of advance care planning (ACP) in frail older adults. Design Cluster randomized controlled trial. Setting Residential care homes in the Netherlands (N=16). Participants Care home residents and community‐dwelling adults receiving home care (N=201; n=101 intervention; n=100 control). Participants were 75 years and older, frail, and capable of consenting to participation. Intervention Adjusted Respecting Choices ACP program. Measurements The primary outcome was change in patient activation (Patient Activation Measure, PAM‐13) between baseline and 12‐month follow‐up. Secondary outcomes included change in quality of life (SF‐12), advance directive (AD) completion, and surrogate decision‐maker appointment. Use of medical care in the 12 months after inclusion was also assessed. Multilevel analyses were performed, controlling for clustering effects and differences in demographics. Results Seventy‐seven intervention participants and 83 controls completed the follow‐up assessment. There were no statistically significant differences between the intervention (–0.26±11.2) and control group (–1.43±10.6) in change scores of the PAM (p=.43) or the SF‐12. Of intervention group participants, 93% completed an AD, and 94% appointed a decision‐maker. Of control participants, 34% completed an AD, and 67% appointed a decision‐maker (p<.001). No differences in the use of medical care were found. Conclusions ACP did not increase levels of patient activation or quality of life but did increase completion of ADs and appointment of surrogate decision‐makers. It did not affect use of medical care.