TY - JOUR
T1 - Patients With Advanced Cancer Choose Less Aggressive Medical Treatment on Vignettes After Using a Computer-Based Decision Aid
AU - Green, Michael J.
AU - Van Scoy, Lauren J.
AU - Foy, Andrew J.
AU - Dimmock, Anne E.F.
AU - Lehman, Erik
AU - Levi, Benjamin H.
N1 - Funding Information:
Individuals using an educational ACP decision aid were less likely to want aggressive medical treatment than those completing standard living wills. These findings have implications not only for how to respect patient’s wishes but also potentially for reducing costs at the end of life. advance care planning decision aids advance directives patient preferences RTC American Cancer Society https://doi.org/10.13039/100000048 RSGHP-08-00501-CPHPS edited-state corrected-proof typesetter ts3 Declaration of Conflicting Interests The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Michael J. Green and Dr Benjamin H. Levi are the co-creators of the decision aid, Making Your Wishes Known , which was developed for research purposes and for use free of charge. A commercial version of the decision aid called My Living Voice is owned by Vital Decisions, and Drs Green and Levi have financial interest in its success through a consulting arrangement with Vital Decisions. All research involving Making Your Wishes Known or My Living Voice is carefully monitored by Penn State’s institutional review board and Conflict of Interest Review Committee. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by grant #RSGHP-08-00501-CPHPS, “End-of-Life Health Care Decisions by Patients with Advanced Cancer,” from the American Cancer Society. ORCID iD Michael J. Green https://orcid.org/0000-0002-4828-4749 Lauren J. Van Scoy https://orcid.org/0000-0003-0984-1474 Supplemental Material Supplemental material for this article is available online.
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background: Although patients often prefer less rather than more treatment at the end of life, in the absence of contrary instructions, the medical profession’s de facto position is to treat aggressively. It is unknown whether a computer-based decision aid can affect treatment choices. Methods: Secondary analysis of a single-center, single-blind randomized controlled trial of an advance care planning (ACP) intervention among 200 patients with stage IV cancer. Participants were randomized to intervention (Making Your Wishes Known, a values-neutral, educational, computer-based decision aid) or control (standard living will + brochure). After reading a hypothetical clinical vignette, participants were asked whether they would want 11 medical/surgical treatments in that situation (dialysis, cardiopulmonary resuscitation [CPR], ventilator, feeding tube, etc). The median number of treatments wanted by participants was compared between groups, and logistic regression was used to compare between-group likelihood of not wanting each specific treatment. Results: The median number of treatments wanted was 1 in the intervention group versus 5 in the control (P <.001). For 6 of 11 treatments, the intervention group was significantly less likely than control to want aggressive treatment. Most notably, compared to control, intervention participants were less likely to want CPR (odds ratio [OR] = 0.31), short-term mechanical ventilation (OR = 0.34), short-term dialysis (OR = 0.38), surgery (OR = 0.37), and transfusion (OR = 0.21). Conclusions: Individuals using an educational ACP decision aid were less likely to want aggressive medical treatment than those completing standard living wills. These findings have implications not only for how to respect patient’s wishes but also potentially for reducing costs at the end of life.
AB - Background: Although patients often prefer less rather than more treatment at the end of life, in the absence of contrary instructions, the medical profession’s de facto position is to treat aggressively. It is unknown whether a computer-based decision aid can affect treatment choices. Methods: Secondary analysis of a single-center, single-blind randomized controlled trial of an advance care planning (ACP) intervention among 200 patients with stage IV cancer. Participants were randomized to intervention (Making Your Wishes Known, a values-neutral, educational, computer-based decision aid) or control (standard living will + brochure). After reading a hypothetical clinical vignette, participants were asked whether they would want 11 medical/surgical treatments in that situation (dialysis, cardiopulmonary resuscitation [CPR], ventilator, feeding tube, etc). The median number of treatments wanted by participants was compared between groups, and logistic regression was used to compare between-group likelihood of not wanting each specific treatment. Results: The median number of treatments wanted was 1 in the intervention group versus 5 in the control (P <.001). For 6 of 11 treatments, the intervention group was significantly less likely than control to want aggressive treatment. Most notably, compared to control, intervention participants were less likely to want CPR (odds ratio [OR] = 0.31), short-term mechanical ventilation (OR = 0.34), short-term dialysis (OR = 0.38), surgery (OR = 0.37), and transfusion (OR = 0.21). Conclusions: Individuals using an educational ACP decision aid were less likely to want aggressive medical treatment than those completing standard living wills. These findings have implications not only for how to respect patient’s wishes but also potentially for reducing costs at the end of life.
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U2 - 10.1177/1049909119892596
DO - 10.1177/1049909119892596
M3 - Article
C2 - 31830798
AN - SCOPUS:85077465121
VL - 37
SP - 537
EP - 541
JO - American Journal of Hospice and Palliative Medicine
JF - American Journal of Hospice and Palliative Medicine
SN - 1049-9091
IS - 7
ER -