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Background:

Interventions with the potential for broad reach in ambulatory settings are necessary to achieve a life course approach to advance care planning.

Objective:

To examine the effect of a computer-tailored, behavioral health model–based intervention on the engagement of adults in advance care planning recruited from ambulatory care settings.

Design:

Cluster randomized controlled trial with participant-level analysis. (ClinicalTrials.gov: NCT03137459)

Setting:

10 pairs of primary and selected specialty care practices matched on patient sociodemographic information.

Participants:

English-speaking adults aged 55 years or older; 454 adults at practices randomly assigned to usual care and 455 at practices randomly assigned to intervention.

Intervention:

Brief telephone or web-based assessment generating a mailed, individually tailored feedback report with a stage-matched brochure at baseline, 2 months, and 4 months.

Measurements:

The primary outcome was completion of the following 4 advance care planning activities at 6 months: identifying and communicating with a trusted person about views on quality versus quantity of life, assignment of a health care agent, completion of a living will, and ensuring that the documents are in the medical record—assessed by a blinded interviewer. Secondary outcomes were completion of individual advance care planning activities.

Results:

Participants were 64% women and 76% White. The mean age was 68.3 years (SD, 8.3). The predicted probability of completing all advance care planning activities in usual care sites was 8.2% (95% CI, 4.9% to 11.4%) versus 14.1% (CI, 11.0% to 17.2%) in intervention sites (adjusted risk difference, 5.2 percentage points [CI, 1.6 to 8.8 percentage points]). Prespecified subgroup analysis found no statistically significant interactions between the intervention and age, education, or race.

Limitations:

The study was done in a single region and excluded non–English speaking participants. No information was collected about nonparticipants.

Conclusion:

A brief, easily delivered, tailored print intervention increased participation in advance care planning in ambulatory care settings.

Primary Funding Source:

National Institute of Nursing Research and National Institute of Aging.

中文翻译：

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STAMP（分享和谈论我的偏好）干预对完成门诊护理中的多项预先护理计划活动的影响

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背景：

有必要在门诊环境中进行具有广泛影响的干预措施，以实现提前护理计划的生命历程方法。

客观的：

研究基于计算机定制的行为健康模型的干预对成人参与从门诊护理环境中招募的预先护理计划的影响。

设计：

具有参与者水平分析的整群随机对照试验。（ClinicalTrials.gov：NCT03137459）

环境：

10 对与患者社会人口学信息相匹配的初级和选定的专业护理实践。

参与者：

55岁或以上会说英语的成年人；454 名成人在实践中被随机分配到常规护理，455 名在实践中被随机分配到干预。

干涉：

简短的电话或基于网络的评估生成邮寄的、单独定制的反馈报告以及基线、2 个月和 4 个月的阶段匹配手册。

测量：

主要结果是在 6 个月时完成以下 4 项预先护理计划活动：确定并与可信赖的人交流关于生活质量与数量的观点、医疗保健代理人的分配、生前遗嘱的完成以及确保文件在病历中——由不知情的采访者评估。次要结果是完成个人预先护理计划活动。

结果：

参与者是 64% 的女性和 76% 的白人。平均年龄为 68.3 岁 (SD, 8.3)。在常规护理场所完成所有预先护理计划活动的预测概率为 8.2%（95% CI，4.9% 至 11.4%），而干预场所的预测概率为 14.1%（CI，11.0% 至 17.2%）（调整风险差异，5.2%点 [CI，1.6 至 8.8 个百分点]）。预先指定的亚组分析发现干预与年龄、教育或种族之间没有统计学意义的相互作用。

限制：

该研究是在一个地区进行的，并排除了非英语参与者。没有收集有关非参与者的信息。

结论：

简短、易于交付、量身定制的印刷干预增加了对门诊护理环境中预先护理计划的参与。

主要资金来源：

国家护理研究所和国家老龄研究所。