Effect of advance care planning discussions with trained nurses in older adults with chronic diseases in Japan.

Abstract

Advance care planning (ACP) discussions are often procrastinated due to both physician and patient factors. However, ACP should be started earlier, to provide more time for reviewing one's values and discussing them with loved ones and medical professionals. This study examined the effectiveness of ACP discussions with health care providers held among older adults with chronic diseases. This was a non-randomized controlled trial among chronically ill people aged 65 years and older. A 6-month follow-up was conducted in the intervention group, in which participants had ACP discussions with trained nurses (n=115), and the control group, in which participants did not discuss ACP (n=115). Questionnaires were administered at baseline and at 6 months, to examine knowledge, ACP readiness and self-efficacy, and comprehensive quality of life (QoL). A total of 200 participants were included in the analysis. The mean age of participants was 69.6 years. There was only a small change in knowledge scores before and after the intervention, with no significant difference between the two groups. ACP engagement was significantly higher in the intervention group than in the control group at 6 months (P=0.016). Comprehensive QoL was significantly higher in the intervention group than in the control group (P<0.001). After adjusting for confounders using multiple regression analysis, there was still an association between those higher scores and the intervention (P=0.01, P=0.044). This study showed that older adults with chronic diseases can have better communication with their families and health care providers and a higher QoL if they engage in ACP discussions with trained nurses at an early stage.