Aim: To examine the effect of a video-supported nurse-led advance care planning to frail geriatric patients on end-of-life decision-making outcomes in patients and their carers.
Design: This is a double-blinded randomized controlled trial with parallel arms.
Methods: The protocol was approved by the Institutional Review Board of the participating hospital on 1 August 2018. Frail elders and their carer if any are enrolled during hospitalization, and undergo randomization after discharged. The intervention group receives a 2-week video-supported nurse-led advance care planning programme (N = 149) while the control group receives a 2-week health education program at home (N = 149). Follow-up surveys via telephone at 1 and 6 months measure outcomes regarding end-of-life decision-making from both the patients and the carers.
Conclusion: Advance care planning discussion is to understand patient's values, preferences and treatment for care on their anticipation of future deterioration. Treatment options for end-of-life care may not be well-received especially elders because in the discussion process, technical medical terms are presented in an abstract, hypothetical way that are hard to understand. The present study aims to evaluate the effect of a nurse-led advance care planning supplementing with a video showing end-of-life treatment options to promote end-of-life care decision-making among frail geriatric patients.
Impact: The results will help identify effective elements of advance care planning and inform the development of an evidence?based structured advance care planning intervention in response to the need for quality end-of-life care.
Trial registration: Chinese Clinical Trial Registry ChiCTR-IOR-17012341.
目的: 研究视频支持的护士主导的老年体弱患者预先护理计划对患者及其护理人员临终决策结果的影响。 设计: 平行双盲随机对照试验。 方法: 该方案于2018年8月1日获得参与医院机构审查委员会的批准。体弱老人及其护理者(如有)在住院期间登记,出院后接受随机分组。干预组使用为期两周的视频支持的、由护士主导的预先护理计划。 对照组在家接受为期两周的健康教育(149例)。在第1个月和第6个月通过电话进行随访,调查患者和护理人员在临终决策方面的结果。 结论: 预先护理计划旨在了解患者对未来病情恶化的预期,患者的价值观、偏好和治疗方法。 临终关怀的治疗方案可能不受欢迎,尤其是老年人,因为在讨论过程中,医学术语是以抽象、假设的方式呈现,难以理解。本研究旨在评估护士主导的预先护理计划的效果,并辅以显示临终治疗方案的视频,以促进体弱老年患者的临终护理决策。 影响: 研究结果将有助于确定预先护理计划的有效要素,并为制定基于证据的结构化预先护理计划干预措施提供依据,以应对优质临终护理的需求。 试验注册: 中国临床试验注册中心ChiCTR-IOR-17012341.
Keywords: advance care planning; advance directives; decision aids; end-of-life; frailty; geriatrics; nurse.
© 2019 John Wiley & Sons Ltd.