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Improving a Full Range of Advance Care Planning Behavior Change and Action Domains: The PREPARE Randomized Trial.
J Pain Symptom Manage. 2018 10; 56(4):575-581.e7.JP

Abstract

CONTEXT

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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 <0.001).

CONCLUSION

Both PREPARE plus an easy-to-read AD and an AD-only markedly increased ACP engagement in a full range of ACP behaviors, including discussions and documentation, and engagement was nearly 100% with PREPARE + AD. Future ACP studies should examine a full range of ACP behaviors beyond ADs and the impact of PREPARE and easy-to-read AD implementation on health care systems.

Authors+Show Affiliations

Eastern Colorado VA Geriatric Research Education and Clinical Center, Denver, Colorado, USA; Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, Colorado, USA. Electronic address: hillary.lum@ucdenver.edu.San Francisco Veterans Affairs Health Care System, San Francisco, California, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

29940209

Citation

Lum, Hillary D., et al. "Improving a Full Range of Advance Care Planning Behavior Change and Action Domains: the PREPARE Randomized Trial." Journal of Pain and Symptom Management, vol. 56, no. 4, 2018, pp. 575-581.e7.
Lum HD, Barnes DE, Katen MT, et al. Improving a Full Range of Advance Care Planning Behavior Change and Action Domains: The PREPARE Randomized Trial. J Pain Symptom Manage. 2018;56(4):575-581.e7.
Lum, H. D., Barnes, D. E., Katen, M. T., Shi, Y., Boscardin, J., & Sudore, R. L. (2018). Improving a Full Range of Advance Care Planning Behavior Change and Action Domains: The PREPARE Randomized Trial. Journal of Pain and Symptom Management, 56(4), 575-e7. https://doi.org/10.1016/j.jpainsymman.2018.06.007
Lum HD, et al. Improving a Full Range of Advance Care Planning Behavior Change and Action Domains: the PREPARE Randomized Trial. J Pain Symptom Manage. 2018;56(4):575-581.e7. PubMed PMID: 29940209.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improving a Full Range of Advance Care Planning Behavior Change and Action Domains: The PREPARE Randomized Trial. AU - Lum,Hillary D, AU - Barnes,Deborah E, AU - Katen,Mary T, AU - Shi,Ying, AU - Boscardin,John, AU - Sudore,Rebecca L, Y1 - 2018/06/27/ PY - 2018/02/21/received PY - 2018/06/13/revised PY - 2018/06/14/accepted PY - 2018/6/26/pubmed PY - 2019/10/23/medline PY - 2018/6/26/entrez KW - Advance care planning KW - advance directive KW - behavior change KW - communication KW - decision aid SP - 575 EP - 581.e7 JF - Journal of pain and symptom management JO - J Pain Symptom Manage VL - 56 IS - 4 N2 - CONTEXT: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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 <0.001). CONCLUSION: Both PREPARE plus an easy-to-read AD and an AD-only markedly increased ACP engagement in a full range of ACP behaviors, including discussions and documentation, and engagement was nearly 100% with PREPARE + AD. Future ACP studies should examine a full range of ACP behaviors beyond ADs and the impact of PREPARE and easy-to-read AD implementation on health care systems. SN - 1873-6513 UR - https://www.unboundmedicine.com/medline/citation/29940209/Improving_a_Full_Range_of_Advance_Care_Planning_Behavior_Change_and_Action_Domains:_The_PREPARE_Randomized_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(18)30312-9 DB - PRIME DP - Unbound Medicine ER -