Article Figures & Data
Tables
- Table 1
Demographic and Clinical Characteristics of Study Participants, by Setting and Overall
Characteristic Setting Total (N = 136) Primary Care (n = 89) Cancer Care (n = 47) Age, mean (SD), y 64.9 (7.9) 66.8 (17.1) 65.6 (11.9) Sex, female, No. (%) 58 (65.2) 12 (25.5) 70 (51.5) Self-rated quality of life, No. (%) Excellent 34 (38.2) 5 (10.6) 39 (28.7) Very good 31 (34.8) 19 (39.6) 50 (36.8) Good 19 (21.3) 16 (33.3) 35 (25.7) Fair 5 (5.6) 6 (12.5) 11 (8.1) Poor 0 (0) 1 (2.1) 1 (0.7) Marital status, No. (%) Married/common law 64 (71.9) 36 (76.6) 100 (73.5) Widowed 9 (10.11) 2 (4.3) 11 (8.1) Never married 7 (7.9) 1 (2.1) 8 (5.9) Divorced/separated 9 (10.1) 8 (17.0) 17 (12.5) Highest level of education, No. (%) Some high school or less 5 (5.6) 5 (10.6) 10 (7.4) High school diploma 9 (10.1) 6 (12.8) 15 (11.0) Some university/college degree 24 (27.0) 15 (31.9) 39 (28.7) University degree 29 (32.6) 13 (27.7) 42 (30.9) Graduate degree 22 (24.7) 8 (17.0) 30 (22.1) Importance of spirituality/religion, No. (%) Extremely important 22 (24.7) 7 (14.9) 29 (21.5) Very important 25 (28.1) 9 (19.1) 34 (25.0) Somewhat important 19 (21.3) 10 (21.3) 29 (21.3) Not very important 12 (13.5) 13 (27.1) 25 (18.4) Not at all important 9 (10.1) 8 (17.0) 17 (13.6) Don’t know 1 (1.1) 0 (0) 1 (0.7) Ethnicity, No. (%) Asian/Pacific Islander 0 (0) 2 (4.3) 2 (1.5) African/black North American 1 (1.1) 0 (0) 1 (0.8) Caucasian/white 82 (92.1) 43 (91.5) 125 (91.9) East Indian 1 (1.1) 1 (2.1) 2 (1.5) First Nations/Inuit/Metis/Aboriginal 2 (2.2) 0 (0) 2 (1.5) Other 3 (3.4) 1 (2.1) 4 (3.2) Language spoken on a daily basis, No. (%) English 85 (95.5) 47 (100.0) 132 (97.0) French 0 (0) 0 (0) 0 (0) Other 4 (4.5) 0 (0) 4 (3.0) Clinical frailty score,27 mean (SD)a 1.9 (0.9) 2.7 (1.2) 2.2 (1.1) Need help with written instructions/materials, No. (%) Never 61 (68.5) 34 (72.3) 95 (70.0) Rarely 19 (21.3) 7 (14.9) 26 (19.1) Sometimes 8 (9.0) 5 (10.6) 13 (9.6) Often 1 (1.1) 1 (2.1) 2 (1.5) Always 0 (0) 0 (0) 0 (0) ↵aScore ranges from 1 to 9, with higher scores indicating greater frailty.
- Table 2
Scores on the Advance Care Planning Engagement Survey at Baseline and Follow-Up in Entire Cohort (N = 136)
Measures Baseline Score, Mean (SD) Follow-upa Score, Mean (SD) Mean Difference (95% CI) Unadjusted P Value Adjusted P Valueb Behavior change process (all scales 1-5) Knowledge 3.2 (1.0) 4.1 (0.8) 0.9 (0.70 to 1.05) <.001 <.001 Contemplation 2.4 (0.9) 3.2 (1.1) 0.8 (0.66 to 0.98) <.001 <.001 Self-efficacy 3.9 (0.8) 4.2 (0.7) 0.3 (0.11 to 0.39) <.001 <.001 Readiness 2.6 (1.0) 3.2 (1.0) 0.6 (0.44 to 0.71) <.001 <.001 Overall 2.9 (0.8) 3.5 (0.8) 0.6 (0.49 to 0.73) <.001 <.001 Action (overall scale 0-21) Medical decision makers (5 items) 1.2 (1.3) 1.5 (1.3) 0.3 (0.09 to 0.48) .004 .004 Health situations (5 items) 1.2 (1.6) 1.4 (1.6) 0.2 (−0.03 to 0.41) .08 .08 Medical decisions (5 items) 1.1 (1.5) 1.3 (1.6) 0.3 (0.07 to 0.48) .01 .01 Flexibility (5 items) 1.2 (0.7) 1.4 (0.8) 0.2 (0.10 to 0.31) <.001 <.001 Asking doctors questions (1 item) 0.1 (0.3) 0.1 (0.3) 0.0 (−0.07 to 0.06) .86 .86 Overall 4.0 (4.9) 5.2 (5.4) 1.2 (0.54 to 1.77) <.001 <.001 - Table 3
Scores on the Advance Care Planning Engagement Survey at Baseline and Follow-Up by Setting
Measures Primary Care (n = 89) Cancer Care (n = 47) Inter-action P Valuec Baseline Score, Mean (SD) Follow-upa Score, Mean (SD) Mean Difference (95% CI) P Valueb Baseline Score, Mean (SD) Follow-upa Score, Mean (SD) Mean Difference (95% CI) P Valueb Behavior change process (all scales 1-5) Knowledge 3.1 (1.0) 4.0 (0.8) 1.0 (0.76 to 1.21) <.001 3.4 (1.1) 4.1 (0.8) 0.7 (0.40 to 0.92) <.001 .07 Contemplation 2.4 (0.8) 3.3 (1.0) 0.9 (0.67 to 1.08) <.001 2.5 (1.0) 3.2 (1.2) 0.7 (0.45 to 0.99) <.001 .65 Self-efficacy 3.9 (0.8) 4.3 (0.7) 0.3 (0.15 to 0.48) <.001 4.0 (0.9) 4.1 (0.8) 0.1 (−0.12 to 0.36) .31 .33 Readiness 2.5 (0.9) 3.2 (0.9) 0.7 (0.50 to 0.84) <.001 2.9 (1.2) 3.3 (1.1) 0.4 (0.18 to 0.59) <.001 .04 Action (overall scale 0-21) Medical decision makers 1.2 (1.4) 1.4 (1.3) 0.2 (−0.08 to 0.39) .18 1.2 (1.3) 1.7 (1.4) 0.5 (0.19 to 0.90) .004 .16 Health situations 1.0 (1.4) 1.3 (1.6) 0.3 (0.01 to 0.51) .04 1.6 (1.8) 1.6 (1.7) 0.1 (−0.36 to 0.49) .76 .18 Medical decisions 1.1 (1.5) 1.3 (1.6) 0.2 (−0.04 to 0.48) .09 1.0 (1.5) 1.4 (1.7) 0.4 (0.01 to 0.71) .04 .82 Flexibility 1.2 (0.6) 1.3 (0.8) 0.2 (0.06 to 0.32) .005 1.3 (0.7) 1.6 (0.9) 0.2 (0.06 to 0.42) .009 .23 Asking doctors questions 0.01 (0.1) 0.1 (0.3) 0.1 (0.02 to 0.14) .007 0.3 (0.5) 0.2 (0.4) −0.2 (−0.32 to −0.03) .02 <.001 Overall 3.7 (4.6) 4.8 (5.2) 1.1 (0.37 to 1.87) <.001 4.6 (5.4) 5.9 (5.8) 1.2 (0.12 to 2.31) <.001 .17
Additional Files
The Article in Brief
Effect of an Interactive Website to Engage Patients in Advance Care Planning in Outpatient Settings
Michelle Howard , and colleagues
Background Advance care planning conversations do not always happen routinely between patients and health care clinicians in primary care or cancer care settings because of system constraints. Online programs may help to engage patients in advance care planning in outpatient settings. A team of Canadian researchers tested PREPARE, a one-hour online program that guides patients through the process of advance care planning. The program was developed by clinicians at the University of California San Francisco and the Veterans Affairs Medical Center, San Francisco, to increase engagement in advance care planning. The goal of the study was to implement the tool in primary care and cancer care outpatient settings in real-world practice to evaluate its impact on advance care planning engagement among older adults in the study.
What This Study Found One hundred thirty-six participants from across multiple outpatient clinic sites in Canada completed the self-paced program and a before-and-after survey. Researchers found they were better equipped to handle advance care planning after completing the online program, with improvements in their knowledge, decision making, confidence and readiness for the planning process. Additionally, participants took modest action to begin advance care planning.
Implications
- The results suggest that self-directed advance care planning tools like PREPARE could support advance care planning initiatives in outpatient health care settings and among the public.
