Abstract

Context Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. Objectives To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Methods Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. Results A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P < 0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P < 0.01) in the Intervention than Control group. Conclusion Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being.

Original languageEnglish (US)
Pages (from-to)1088-1096
Number of pages9
JournalJournal of Pain and Symptom Management
Volume49
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Hope
Advance Care Planning
Anxiety
Neoplasms
Personal Autonomy
Control Groups
Psychology
Physicians
Decision Support Techniques
Tertiary Healthcare
Decision Making

All Science Journal Classification (ASJC) codes

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

@article{401ef4794fba4fe493fe2d6d4decc0f3,
title = "Advance care planning does not adversely affect hope or anxiety among patients with advanced cancer",
abstract = "Context Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. Objectives To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Methods Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ({"}Making Your Wishes Known{"}). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. Results A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP ({\%} correct answers) increased in both the groups, but more so in the Intervention group (13{\%} increase vs. 4{\%}; P < 0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P < 0.01) in the Intervention than Control group. Conclusion Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being.",
author = "Michael Green and Schubart, {Jane R.} and Whitehead, {Megan M.} and Elana Farace and Erik Lehman and Benjamin Levi",
year = "2015",
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doi = "10.1016/j.jpainsymman.2014.11.293",
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Advance care planning does not adversely affect hope or anxiety among patients with advanced cancer. / Green, Michael; Schubart, Jane R.; Whitehead, Megan M.; Farace, Elana; Lehman, Erik; Levi, Benjamin.

In: Journal of Pain and Symptom Management, Vol. 49, No. 6, 01.06.2015, p. 1088-1096.

Research output: Contribution to journalArticle

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T1 - Advance care planning does not adversely affect hope or anxiety among patients with advanced cancer

AU - Green, Michael

AU - Schubart, Jane R.

AU - Whitehead, Megan M.

AU - Farace, Elana

AU - Lehman, Erik

AU - Levi, Benjamin

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Context Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. Objectives To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Methods Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. Results A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P < 0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P < 0.01) in the Intervention than Control group. Conclusion Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being.

AB - Context Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. Objectives To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Methods Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. Results A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P < 0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P < 0.01) in the Intervention than Control group. Conclusion Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being.

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