Mi-Kyung Song1, Sandra E Ward2, Jason P Fine3, Laura C Hanson4, Feng-Chang Lin3, Gerald A Hladik5, Jill B Hamilton6, Jessica C Bridgman7. 1. School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: songm@email.unc.edu. 2. School of Nursing, University of Wisconsin-Madison, Madison, WI. 3. School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC. 4. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. 5. University of North Carolina Kidney Center, Chapel Hill, NC. 6. School of Nursing, Johns Hopkins University, Baltimore, MD. 7. School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Abstract
BACKGROUND: Few trials have examined long-term outcomes of advance care planning (ACP) interventions. We examined the efficacy of an ACP intervention on preparation for end-of-life decision making for dialysis patients and surrogates and for surrogates' bereavement outcomes. STUDY DESIGN: A randomized trial compared an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) to usual care alone, with blinded outcome assessments. SETTING & PARTICIPANTS: 420 participants (210 dyads of prevalent dialysis patients and their surrogates) from 20 dialysis centers. INTERVENTION: Every dyad received usual care. Those randomly assigned to SPIRIT had an in-depth ACP discussion at the center and a follow-up session at home 2 weeks later. PRIMARY OUTCOMES: preparation for end-of-life decision making, assessed for 12 months, included dyad congruence on goals of care at end of life, patient decisional conflict, surrogate decision-making confidence, and a composite of congruence and surrogate decision-making confidence. SECONDARY OUTCOMES: bereavement outcomes, assessed for 6 months, included anxiety, depression, and posttraumatic distress symptoms completed by surrogates after patient death. PRIMARY OUTCOMES: adjusting for time and baseline values, dyad congruence (OR, 1.89; 95% CI, 1.1-3.3), surrogate decision-making confidence (β=0.13; 95% CI, 0.01-0.24), and the composite (OR, 1.82; 95% CI, 1.0-3.2) were better in SPIRIT than controls, but patient decisional conflict did not differ between groups (β=-0.01; 95% CI, -0.12 to 0.10). SECONDARY OUTCOMES: 45 patients died during the study. Surrogates in SPIRIT had less anxiety (β=-1.13; 95% CI, -2.23 to -0.03), depression (β=-2.54; 95% CI, -4.34 to -0.74), and posttraumatic distress (β=-5.75; 95% CI, -10.9 to -0.64) than controls. LIMITATIONS: Study was conducted in a single US region. CONCLUSIONS: SPIRIT was associated with improvements in dyad preparation for end-of-life decision making and surrogate bereavement outcomes.
RCT Entities:
BACKGROUND: Few trials have examined long-term outcomes of advance care planning (ACP) interventions. We examined the efficacy of an ACP intervention on preparation for end-of-life decision making for dialysis patients and surrogates and for surrogates' bereavement outcomes. STUDY DESIGN: A randomized trial compared an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) to usual care alone, with blinded outcome assessments. SETTING & PARTICIPANTS: 420 participants (210 dyads of prevalent dialysis patients and their surrogates) from 20 dialysis centers. INTERVENTION: Every dyad received usual care. Those randomly assigned to SPIRIT had an in-depth ACP discussion at the center and a follow-up session at home 2 weeks later. PRIMARY OUTCOMES: preparation for end-of-life decision making, assessed for 12 months, included dyad congruence on goals of care at end of life, patient decisional conflict, surrogate decision-making confidence, and a composite of congruence and surrogate decision-making confidence. SECONDARY OUTCOMES: bereavement outcomes, assessed for 6 months, included anxiety, depression, and posttraumatic distress symptoms completed by surrogates after patientdeath. PRIMARY OUTCOMES: adjusting for time and baseline values, dyad congruence (OR, 1.89; 95% CI, 1.1-3.3), surrogate decision-making confidence (β=0.13; 95% CI, 0.01-0.24), and the composite (OR, 1.82; 95% CI, 1.0-3.2) were better in SPIRIT than controls, but patient decisional conflict did not differ between groups (β=-0.01; 95% CI, -0.12 to 0.10). SECONDARY OUTCOMES: 45 patients died during the study. Surrogates in SPIRIT had less anxiety (β=-1.13; 95% CI, -2.23 to -0.03), depression (β=-2.54; 95% CI, -4.34 to -0.74), and posttraumatic distress (β=-5.75; 95% CI, -10.9 to -0.64) than controls. LIMITATIONS: Study was conducted in a single US region. CONCLUSIONS: SPIRIT was associated with improvements in dyad preparation for end-of-life decision making and surrogate bereavement outcomes.
Authors: Tim Luckett; Marcus Sellars; Jennifer Tieman; Carol A Pollock; William Silvester; Phyllis N Butow; Karen M Detering; Frank Brennan; Josephine M Clayton Journal: Am J Kidney Dis Date: 2014-01-14 Impact factor: 8.860
Authors: Paul R Duberstein; Paul K Maciejewski; Ronald M Epstein; Joshua J Fenton; Benjamin Chapman; Sally A Norton; Michael Hoerger; Marsha N Wittink; Daniel J Tancredi; Guibo Xing; Supriya Mohile; Richard L Kravitz; Holly G Prigerson Journal: J Palliat Med Date: 2019-06-25 Impact factor: 2.947
Authors: Nwamaka D Eneanya; Julia B Wenger; Katherine Waite; Stanley Crittenden; Derya B Hazar; Angelo Volandes; Jennifer S Temel; Ravi Thadhani; Michael K Paasche-Orlow Journal: Am J Nephrol Date: 2016-06-29 Impact factor: 3.754
Authors: Harriet L Mather; Heather Coats; Kristen Desanto; J Nicholas Dionne-Odom; Cardinale B Smith; Laura P Gelfman Journal: J Palliat Med Date: 2019-04 Impact factor: 2.947
Authors: Keren Ladin; Renuka Pandya; Allison Kannam; Rohini Loke; Tira Oskoui; Ronald D Perrone; Klemens B Meyer; Daniel E Weiner; John B Wong Journal: Am J Kidney Dis Date: 2018-02-01 Impact factor: 8.860
Authors: Karen O Moss; Nancy L Deutsch; Patricia J Hollen; Virginia G Rovnyak; Ishan C Williams; Karen M Rose Journal: Am J Hosp Palliat Care Date: 2018-03-14 Impact factor: 2.500