Effects of advance care planning in care dependent community-dwelling older persons (STADPLAN): A cluster-randomised controlled trial.
| Autor: | Hoffmann F; Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany., Schnakenberg R; Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany., Silies K; Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany., Berg A; Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany., Kirchner Ä; Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany., Jaschke J; Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany., Haastert B; mediStatistica, Wuppertal, Germany., Wiese B; Institute for General Practice, Hannover Medical School, Hannover, Germany., Köberlein-Neu J; Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany., Meyer G; Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany., Köpke S; Institute of Nursing Sciences, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany. |
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| Jazyk: | angličtina |
| Zdroj: | Palliative medicine [Palliat Med] 2023 Sep; Vol. 37 (8), pp. 1193-1201. Date of Electronic Publication: 2023 Jun 13. |
| DOI: | 10.1177/02692163231180322 |
| Abstrakt: | Background: Most randomised controlled trials on advance care planning were conducted in people with advanced, life-limiting illnesses or in institutional settings. There are few studies on its effect in older people living in the community. Aim: To determine the effects of advance care planning in older community dwelling people. Design: The STADPLAN study was a cluster-randomised trial with 12 months follow-up. The complex intervention comprised a 2-days training for nurse facilitators that delivered a formal advance care planning counselling and a written information brochure. Patients in the control group received optimised usual care, that is, provision of a short information brochure. Setting/participants: Home care services in three regions of Germany were randomised using concealed allocation. Care dependent clients of participating home care services, aged 60 years or older, and rated to have a life-expectancy of at least 4 weeks were included. Primary outcome was active participation in care at 12 months, assessed by blinded investigators using the Patient Activation Measure (PAM-13). Results: Twenty-seven home care services and 380 patients took part. Three hundred seventy-three patients were included in the primary analysis ( n = 206 in the intervention and n = 167 in the control group). There was no statistically significant difference between the intervention and control group with regard to the PAM-13 after 12 months (75.7 vs 78.4; p = 0.13). No differences in quality of life, anxiety and depression, advance care planning engagement, and in proportion of participants with advance directives were found between groups. Conclusions: The intervention showed no relevant effects on patient activation or quality of life in community dwelling older persons, possibly indicating the need for more tailored interventions. However, results are limited by a lack of statistical power. Trial Registration: German Clinical Trials Register: DRKS00016886. |
| Databáze: | MEDLINE |
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