RT Journal Article
SR Electronic
T1 Effect of an Interactive Website to Engage Patients in Advance Care Planning in Outpatient Settings
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 110
OP 117
DO 10.1370/afm.2471
VO 18
IS 2
A1 Howard, Michelle
A1 Robinson, Carole A.
A1 McKenzie, Michael
A1 Fyles, Gillian
A1 Sudore, Rebecca L.
A1 Andersen, Elizabeth
A1 Arora, Neha
A1 Barwich, Doris
A1 Bernard, Carrie
A1 Elston, Dawn
A1 Heyland, Rebecca
A1 Klein, Doug
A1 McFee, Erin
A1 Mroz, Lawrence
A1 Slaven, Marissa
A1 Tan, Amy
A1 Heyland, Daren K.
YR 2020
UL http://www.annfammed.org/content/18/2/110.abstract
AB PURPOSE Online programs may help to engage patients in advance care planning in outpatient settings. We sought to implement an online advance care planning program, PREPARE (Prepare for Your Care; http://www.prepareforyourcare.org), at home and evaluate the changes in advance care planning engagement among patients attending outpatient clinics.METHODS We undertook a prospective before-and-after study in 15 primary care clinics and 2 outpatient cancer centers in Canada. Patients were aged 50 years or older (primary care) or 18 years or older (cancer care) and free of cognitive impairment. They used the PREPARE website over 6 weeks, with reminders sent at 2 or 4 weeks. We used the 55-item Advance Care Planning Engagement Survey, which measures behavior change processes (knowledge, contemplation, self-efficacy, readiness) on 5-point scales and actions relating to substitute decision makers, quality of life, flexibility for the decision maker, and asking doctors questions on an overall scale from 0 to 21; higher scores indicate greater engagement.RESULTS In total, 315 patients were screened and 172 enrolled, of whom 75% completed the study (mean age = 65.6 years, 51% female, 35% had cancer). The mean behavior change process score was 2.9 (SD 0.8) at baseline and 3.5 (SD 0.8) at follow-up (mean change = 0.6; 95% CI, 0.49-0.73); the mean action measure score was 4.0 (SD 4.9) at baseline and 5.2 (SD 5.4) at follow-up (mean change = 1.2; 95% CI, 0.54-1.77). The effect size was moderate (0.75) for the former and small (0.23) for the latter. Findings were similar in both primary care and cancer care populations.CONCLUSIONS Implementation of the online PREPARE program in primary care and cancer care clinics increased advance care planning engagement among patients.