Patient-centered and efficacious advance care planning in cancer: Protocol and key design considerations for the PEACe-compare trial

• Published in: Contemporary clinical trials Vol. 96; p. 106071
• Main Authors: Resick, Judith M., Arnold, Robert M., Sudore, Rebecca L., Farrell, David, Belin, Shane, Althouse, Andrew D., Ferrell, Betty, Hammes, Bernard J., Chu, Edward, White, Douglas B., Rak, Kimberly J., Schenker, Yael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2020
• Subjects: Advance Care Planning; Advance Directives; Advance health care planning; Caregiver; Communication; Decision making; Health-related quality of life; Humans; Intervention study, cancer; Neoplasms - therapy; Patient-Centered Care; Randomized Controlled Trials as Topic; Single-blind methods; Terminal Care; Health-related quality of life; Advance health care planning; Decision making; Single-blind methods; Intervention study, cancer; Caregiver
• ISSN: 1551-7144; 1559-2030
• DOI: 10.1016/j.cct.2020.106071

Failure to deliver care near the end of life that reflects the needs, values and preferences of patients with advanced cancer remains a major shortcoming of our cancer care delivery system. A mixed-methods comparative effectiveness trial of in-person advance care planning (ACP) discussions versus web-based ACP is currently underway at oncology practices in Western Pennsylvania. Patients with advanced cancer and their caregivers are invited to enroll. Participants are randomized to either (1) in-person ACP discussions via face-to-face visits with a nurse facilitator following the Respecting Choices® Conversation Guide or (2) web-based ACP using the PREPARE for your care™ web-based ACP tool. The trial compares the effect of these two interventions on patient and family caregiver outcomes (engagement in ACP, primary outcome; ACP discussions; advance directive (AD) completion; quality of end-of-life (EOL) care; EOL goal attainment; caregiver psychological symptoms; healthcare utilization at EOL) and assesses implementation costs. Factors influencing ACP effectiveness are assessed via in-depth interviews with patients, caregivers and clinicians. This trial will provide new and much-needed empirical evidence about two patient-facing ACP approaches that successfully overcome limitations of traditional written advance directives but entail very different investments of time and resources. It is innovative in using mixed methods to evaluate not only the comparative effectiveness of these approaches, but also the contexts and mechanisms influencing effectiveness. Data from this study will inform clinicians, payers and health systems seeking to adopt and scale the most effective and efficient ACP strategy in real-world oncology settings. •Advance care planning (ACP) helps ensure medical care reflects patients' goals.•In-person and web-based ACP differ in costs, scalability, and implementation.•It is unknown which ACP method is most impactful for patients with advanced cancer.•This mixed-methods trial compares effectiveness of in-person versus web-based ACP.