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Patient–caregiver dyads advance care plan value discussions: randomised controlled cancer trial of video decision support tool
  1. Natasha G Michael1,2,
  2. Ekavi Georgousopoulou2,
  3. Graham Hepworth3,
  4. Adelaide Melia1,
  5. Roisin Tuohy4,
  6. Merlina Sulistio1,2 and
  7. David Kissane1,2
  1. 1Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia
  2. 2School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
  3. 3Statistical Consulting Centre, The University of Melbourne, Carlton, Victoria, Australia
  4. 4Faulty of Business and Economics, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Dr Natasha G Michael, Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia; nmichael{at}cabrini.com.au

Abstract

Objective Uptake of advance care planning (ACP) in cancer remains low. An emphasis on personal value discussions and adoption of novel interventions may serve as the catalyst to increase engagement. This study examined the effectiveness of a video decision support tool (VDST) modelling values conversations in cancer ACP.

Methods This single site, open-label, randomised controlled trial allocated patient–caregiver dyads on a 1:1 ratio to VDST or usual care (UC). Previously used written vignettes were converted to video vignettes using standard methodology. We evaluated ACP document completion rates, understanding and perspectives on ACP, congruence in communication and preparation for decision-making.

Results Participants numbered 113 (60.4% response rate). The VDST did not improve overall ACP document completion (37.7% VDST; 36.7% UC). However, the VDST improved ACP document completion in older patients (≥70) compared with younger counterparts (<70) (OR=0.308, 95% CI 0.096 to 0.982, p=0.047), elicited greater distress in patients (p=0.015) and improved patients and caregivers ratings for opportunities to discuss ACP with health professionals. ACP improved concordance in communication (VDST p=0.006; UC p=0.045), more so with the VDST (effect size: VDST 0.7; UC 0.54). Concordance in communication also improved in both arms with age.

Conclusion The VDST failed to improve ACP document completion rates but highlighted that exploring core patient values may improve concordance in patient–caregiver communication. Striving towards a more rigorous design of the VDST intervention, incorporating clinical outcome scenarios with values conversations may be the catalyst needed to progress ACP towards a more fulfilling process for those who partake in it.

Trial registration number ACTRN12620001035910.

  • cancer
  • supportive care
  • psychological care
  • family management
  • end of life care
  • communication

Data availability statement

Data are available upon reasonable request. The datasets generated during the study will be available from the corresponding author on reasonable request.

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Data availability statement

Data are available upon reasonable request. The datasets generated during the study will be available from the corresponding author on reasonable request.

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Footnotes

  • Contributors NGM and DK designed the initial study; NGM and AM assisted with piloting and modification; NM, AM and MS led recruitment; RT assisted with data chelation and management; NM, EG, RT and GH conducted statistical analysis; NM wrote the initial manuscript and all authors approved the final manuscript. NM is responsible for the overall content as guarantor.

  • Funding This research was funded by the Bethlehem Research Foundation Grant (Grant Number 1709) and the Cabrini Foundation Medical Oncology Research Grant.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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