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Abstract
Background We developed Accordons-nous, a smartphone app to support patients in the advance care planning (ACP) process. The app raises awareness, facilitates communication, and helps to express values and preferences for care, and to write advance directives (AD).
Objective Measure the impact of distributing Accordons-nous, compared to the distribution of a leaflet, on common patients’ propensity to engage in an ACP process. Secondary: test the effect of socio-demographic factors on the propensity to engage in ACP.
Method Pre-post randomized control study. Participants were common patients approached in medical waiting rooms. They received the app (treatment) or an information leaflet (control) and responded to two questionnaires (at recruitment and 2–4 weeks later). We measured improvement on reported Contemplation of an event relevant to ACP, Decision about treatment in case of that event, Discussion about it with relatives or health professionals, and Writing AD.
Results 473 participants recruited and full responses from 312. Overall the intervention (control and treatment together) affected positively the mean reported ACP engagement on all variables: new or renewed Contemplation 54%; increase in Decision +8%, Discussion +11%, and Writing +1%, compared to the baseline. Compared to the control (leaflet), the treatment group (app) had a larger effect size on all variables: between groups difference in Contemplation +11% (logistic regression, p=.05), Decision +1% (but p=.94 on this variable), Discussion +5% (p=.05), and Writing AD +5% (p=0.03). Moreover, increase in age is positively correlated with having written AD at inclusion (21% among retired compared to 2% among young adults) and with the propensity to write AD after our intervention (logistic regression, p=.001).
Conclusions When distributed without specific counselling, our tool helps increasing reported ACP engagement although the effect sizes remain modest. Further studies should investigate the effect of the app when it is used in support of ACP consultations.