Abstract
BackgroundViews on advance care planning (ACP) has shifted from a focus solely on treatment decisions at the end-of-life and medically orientated advanced directives to encouraging conversations on personal values and life goals, patient-caregiver communication and decision making, and family preparation. This study will evaluate the potential utility of a video decision support tool (VDST) that models values-based ACP discussions between cancer patients and their nominated caregivers to enable patients and families to achieve shared-decisions when completing ACP’s.MethodsThis open-label, parallel-arm, phase II randomised control trial will recruit cancer patient-caregiver dyads across a large health network. Previously used written vignettes will be converted to video vignettes using the recommended methodology. Participants will be ≥18 years and be able to complete questionnaires. Dyads will be randomised in a 1:1 ratio to a usual care (UC) or VDST group. The VDST group will watch a video of several patient-caregiver dyads communicating personal values across different cancer trajectory stages and will receive verbal and written ACP information. The UC group will receive verbal and written ACP information. Patient and caregiver data will be collected individually via an anonymous questionnaire developed for the study, pre and post the UC and VDST intervention.Our primary outcome will be ACP completion rates. Secondarily, we will compare patient-caregiver (i) attitudes towards ACP, (ii) congruence in communication, and (iii) preparation for decision-making.ConclusionWe need to continue to explore innovative ways to engage cancer patients in ACP. This study will be the first VDST study to attempt to integrate values-based conversations into an ACP intervention. This pilot study’s findings will assist with further refinement of the VDST and planning for a future multisite study.Trial registrationAustralian New Zealand Clinical Trials Registry No: ACTRN12620001035910. Registered 12 October 2020. Retrospectively registered.
Highlights
Views on advance care planning (ACP) has shifted from a focus solely on treatment decisions at the end-of-life and medically orientated advanced directives to encouraging conversations on personal values and life goals, patient-caregiver communication and decision making, and family preparation
A recent systematic review and meta-analysis of 10 randomised controlled trial’s (RCT’s) (2220 patients) examining video decision support tool (VDST) to assist ACP found that patients who use a VDST were less likely to indicate a preference for cardiopulmonary resuscitation and acquired improved ACP knowledge [12]
This study aims to build on the paucity of research exploring conversations about individual values between cancer patient-caregiver dyads and examining their impact on EOL decision-making and ACP
Summary
Views on advance care planning (ACP) has shifted from a focus solely on treatment decisions at the end-of-life and medically orientated advanced directives to encouraging conversations on personal values and life goals, patient-caregiver communication and decision making, and family preparation. All people have the right to make decisions about how they are cared for in the future Many lose this ability as they approach the end-of-life (EOL). Contemporary views have shifted from ACP focused solely on treatment decisions at the EOL and medically orientated advanced directives. It instead encourages conversations that communicate personal values and life goals to support patient-caregiver communication and decision-making [9], family preparation [10, 11], and the actualization of ACP’s through innovative interventions [12]
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