Background & Aims

Transplant-ineligible patients with advanced liver disease rarely receive timely advance care planning (ACP). Tools are needed to educate these patients about medical interventions available at the end of life to promote ACP.

Methods

This single-site pilot randomized controlled trial assessed the feasibility, acceptability, and preliminary efficacy of an ACP video decision support tool for improving transplant-ineligible advanced liver disease patients’ knowledge about and preferences for end-of-life care. Intervention participants watched a 5-minute video depicting 3 levels of goals of care: life-prolonging care (cardiopulmonary resuscitation [CPR] and intubation), life-limiting care (hospitalization, no CPR/intubation), and comfort care. Control subjects received only a verbal narrative of these 3 levels of goals of care. The primary outcome was feasibility (≥60% enrollment rate). Secondary outcomes included acceptability of the video, patients’ knowledge of end-of-life care options (6-item test; range, 0–6), and postintervention goals-of-care and CPR or intubation preferences.

Results

We enrolled 85% (n = 50 of 59) of eligible patients randomized to the video (n = 26) or verbal (n = 24) arm. In the video arm, 81% of patients reported being very comfortable watching the video. Patients in the video arm had higher mean knowledge scores (5.7 vs 4.8; P < .001) and were less likely to prefer to receive CPR compared with patients in the verbal arm (35% vs 63%; P = .09).

Conclusions

An ACP video decision support tool to improve knowledge about and preferences for end-of-life care is both feasible and highly acceptable to transplant-ineligible patients with advanced liver disease with a high enrollment rate and promising preliminary efficacy. Future studies should examine the efficacy of the ACP video for enhancing the quality of their end-of-life care. (ClinicalTrials.gov, Number: NCT03557086).

中文翻译：

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针对晚期肝病患者的预先护理计划视频决策工具的随机对照试验

 背景与目标

不适合移植的晚期肝病患者很少得到及时的预先护理计划（ACP）。需要工具来教育这些患者临终时可用的医疗干预措施，以促进 ACP。

 方法

这项单中心试点随机对照试验评估了 ACP 视频决策支持工具的可行性、可接受性和初步功效，以提高不适合移植的晚期肝病患者对临终护理的了解和偏好。干预参与者观看了一段 5 分钟的视频，描述了 3 个级别的护理目标：延长生命的护理（心肺复苏 [CPR] 和插管）、限制生命的护理（住院、不进行 CPR/插管）和舒适护理。对照受试者仅接受这 3 个护理目标级别的口头叙述。主要结局是可行性（≥60% 的入学率）。次要结局包括视频的可接受性、患者对临终护理选择的了解（6 项测试；范围，0-6）以及干预后护理目标和心肺复苏或插管偏好。

 结果

我们招募了 85%（59 名中的 50 名）符合条件的患者，随机分为视频组（n = 26）或口头组（n = 24）。在视频组中，81% 的患者表示观看视频非常舒服。与语言组患者相比，视频组患者的平均知识得分较高（5.7 vs 4.8； P < .001），并且不太愿意接受心肺复苏（35% vs 63%； P = .09）。

 结论

ACP 视频决策支持工具可提高对临终关怀的了解和偏好，对于不适合移植的晚期肝病患者来说既可行又高度可接受，入组率高且初步疗效有希望。未来的研究应该检验 ACP 视频对于提高临终关怀质量的功效。 （ClinicalTrials.gov，编号：NCT03557086）。