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Collaborative advance care planning in palliative care: a randomised controlled trial
  1. Carola Seifart1,
  2. Martin Koch2,
  3. Svenja Herzog3,
  4. Nico Leppin4,
  5. Katharina Nagelschmidt5,
  6. Jorge Riera Knorrenschild6,
  7. Nina Timmesfeld7,
  8. Robin Denz7,
  9. Ulf Seifart8,
  10. Winfried Rief9 and
  11. Pia Von Blanckenburg10
  1. 1 Faculty of Medicine; Deans Office, Philipps-Universität Marburg, Marburg, Germany
  2. 2 Faculty of Medicine, Department Haematology and Oncology, Dresden University Hospital, Dresden, Germany
  3. 3 Central Hospital of the Detention Center Hamburg, Hamburg, Germany
  4. 4 Faculty of Psychology, Department Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
  5. 5 Faculty of Psychology, Department of Clinical Psychology and Psychotherapy, Philipps-Universitat Marburg, Marburg, Germany
  6. 6 Faculty od Medicine; Department of Internal Medicine, Div. Haematology and Oncology, Philipps-Universitat Marburg, Marburg, Germany
  7. 7 Department of Medical Computer Science, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
  8. 8 Clinic Sonnenblick, Marburg, Germany
  9. 9 Faculty od Psychology, Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
  10. 10 Faculty of Psychology, Clinical Psychology and Psycohtherapy, Philipps-Universität Marburg, Marburg, Germany
  1. Correspondence to Professor Carola Seifart, Faculty of Medicine, Philipps-Universität Marburg, Marburg 35037, Germany; carola.seifart{at}


Objective An effective tool for establishing concordant end-of-life (EOL) care in patients with cancer is advance care planning (ACP). However, various barriers, including psychological obstacles, hamper the access to ACP. Therefore, a new conceptual model combining a psycho-oncological approach with structured ACP was developed. The effectiveness and efficiency of this new concept of collaborative ACP (col-ACP) is evaluated in the present randomised controlled trial in patients with palliative cancer.

Methods 277 patients with palliative cancer and their relatives were randomised into three groups (1) collaborative ACP (col-ACP) consisting of a psycho-oncological approach addressing barriers to EOL conversations followed by a standardised ACP procedure, (2) supportive intervention (active control) and (3) standard medical care.

Results Patients in the col-ACP group completed advance directives (p<0.01) and healthcare proxies (p<0.01) significantly more often. Additionally, they felt better planned ahead for their future treatment (p<0.01) and were significantly more confident that their relatives were aware of their treatment wishes (p=0.03). In fact, their goals of care were known and highly fulfilled. However, patients’ and caregivers’ quality of life, patients’ stress, depression and peace did not differ between the groups.

Conclusions The new, well-received, concept of col-ACP improves readiness and access to ACP and results in more consistent EOL care. Further, even if no direct influence on quality of life could be proven, it supports patients in planning their treatment, making autonomous decisions and regaining self-efficacy in the face of life-limiting cancer. Therefore, a closer interlocking and information exchange between psycho-oncological and ACP services seems to be reasonable.

Trial registration number NCT03387436.

  • End of life care
  • Supportive care
  • Communication
  • Cancer
  • Psychological care

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Contributors CS is principal investigator, formulated the research question, conceptualised the study design and wrote the manuscript and is responsible for the overall content. MK and SH were research assistants in the trial, recruits patients, coordinates the collection of outcome measures and reviced the manuscript. NL and KN are research assistants, carry out the intervention, contributed to the intervention manual and helped writing the manual. US recruit patients and contributed to the manuscript JRK and NT are coinvestigators and contributed to its design. JRK supervised the recruitment of patients, NT conceived the statistical design and NT and RD have calculated the statistics and results. WR and PVB are coinvestigators. PVB wrote the intervention manual, supervises the intervention and contributed to the manuscript. WR contributed to the study design.

  • Funding The research is funded by the German Federal Ministry of research and education to CS. Funding-ID: 01GY1708. MK has received funding for travel expenses by Brisol Myer Squib in 2018.

  • 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.