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Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: a study protocol for a randomised controlled trial.
BMJ Open. 2019 01 24; 9(1):e023107.BO

Abstract

INTRODUCTION

It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being.

METHODS AND ANALYSIS

Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be ≥18 years screened as potentially having palliative care needs and at risk of dying in 6-12 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient's health-related quality-of-life and quality of chronic disease care; (ii) caregiver's health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff's self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention.

ETHICS AND DISSEMINATION

Approved by South-East Sydney Local Health District Human Research Ethics Committee and NSW Population and Health Services Research Ethics Committee. Results will be disseminated via conference presentations, journal publications, seminars and invited talks.

TRIAL REGISTRATION NUMBER

ACTRN12617000280303.

Authors+Show Affiliations

School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia. Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.Post Acute Care Services, Prince of Wales Hospital, South Eastern Sydney, Sydney, New South Wales, Australia.Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.Southcare, Sutherland Hospital, South Eastern Sydney, Sydney, New South Wales, Australia.Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney and Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.Australian Centre for Public and Population Health Research, University of Technology, Sydney, New South Wales, Australia.Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia.Aged, Chronic Care & Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia.Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.

Pub Type(s)

Clinical Trial Protocol
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30679290

Citation

Rhee, Joel, et al. "Advance Care Planning for Patients With Advanced Illnesses Attending Hospital Outpatient Clinics Study: a Study Protocol for a Randomised Controlled Trial." BMJ Open, vol. 9, no. 1, 2019, pp. e023107.
Rhee J, Meller A, Krysinska K, et al. Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: a study protocol for a randomised controlled trial. BMJ Open. 2019;9(1):e023107.
Rhee, J., Meller, A., Krysinska, K., Gonski, P., Naganathan, V., Zwar, N., Hayen, A., Cullen, J., O'Keefe, J. A., McDonald, J., Harris-Roxas, B., & Caplan, G. A. (2019). Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: a study protocol for a randomised controlled trial. BMJ Open, 9(1), e023107. https://doi.org/10.1136/bmjopen-2018-023107
Rhee J, et al. Advance Care Planning for Patients With Advanced Illnesses Attending Hospital Outpatient Clinics Study: a Study Protocol for a Randomised Controlled Trial. BMJ Open. 2019 01 24;9(1):e023107. PubMed PMID: 30679290.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: a study protocol for a randomised controlled trial. AU - Rhee,Joel, AU - Meller,Anne, AU - Krysinska,Karolina, AU - Gonski,Peter, AU - Naganathan,Vasi, AU - Zwar,Nicholas, AU - Hayen,Andrew, AU - Cullen,John, AU - O'Keefe,Julie-Ann, AU - McDonald,Julie, AU - Harris-Roxas,Ben, AU - Caplan,Gideon A, Y1 - 2019/01/24/ PY - 2019/1/26/entrez PY - 2019/1/27/pubmed PY - 2020/2/14/medline KW - advance care planning KW - geriatric medicine KW - outpatient clinic SP - e023107 EP - e023107 JF - BMJ open JO - BMJ Open VL - 9 IS - 1 N2 - INTRODUCTION: It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being. METHODS AND ANALYSIS: Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be ≥18 years screened as potentially having palliative care needs and at risk of dying in 6-12 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient's health-related quality-of-life and quality of chronic disease care; (ii) caregiver's health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff's self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention. ETHICS AND DISSEMINATION: Approved by South-East Sydney Local Health District Human Research Ethics Committee and NSW Population and Health Services Research Ethics Committee. Results will be disseminated via conference presentations, journal publications, seminars and invited talks. TRIAL REGISTRATION NUMBER: ACTRN12617000280303. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/30679290/Advance_care_planning_for_patients_with_advanced_illnesses_attending_hospital_outpatient_clinics_study:_a_study_protocol_for_a_randomised_controlled_trial_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=30679290 DB - PRIME DP - Unbound Medicine ER -