Evaluation of a Collaborative Advance Care Planning Intervention among Older Adult Home Health Patients and Their Caregivers.

Abstract

<b><i>Background:</i></b> Caregivers are decision stakeholders; yet, few interventions have been developed to help patients and caregivers collaborate on advance care planning (ACP). <b><i>Objective:</i></b> To evaluate a theory-based ACP pilot intervention, <i>Deciding Together</i>, to improve decisional quality, readiness, collaboration, and concordance in ACP decisions for older adult home health (HH) patients and caregivers. <b><i>Design:</i></b> A one-group, pre- and posttest study using matched questionnaires was conducted. The intervention consisted of a clinical vignette, theoretically guided conversation prompts, and a shared decision-making activity. <b><i>Setting/Subjects:</i></b><i>N</i> = 36 participants (<i>n</i> = 18 HH patients; <i>n</i> = 18 family and nonfamily caregivers) were purposively recruited from a HH agency to participate in the intervention at patients' homes. <b><i>Measurements:</i></b> Demographic and baseline measures were collected for relationship quality, health status, and previous ACP engagement. Outcome measures included perceptions of collaboration, readiness for ACP, concordance in life-sustaining treatment preferences (cardiopulmonary resuscitation, antibiotics, artificial nutrition and hydration, and mechanical ventilation), and decisional conflict. Descriptive statistics, Cohen's κ coefficients, paired <i>t</i> tests, McNemar's tests, and Wilcoxon signed-rank tests (and effect size estimates, <i>r</i> = <i>z</i>/√<i>N</i>) were calculated using R-3.5.1 (<i>p</i> < 0.05). Single value imputation was used for missing values. <b><i>Results:</i></b> While no significant differences were found for perceptions of collaboration, and readiness for ACP, patients (<i>r</i> = 0.38, <i>p</i> = 0.02) and caregivers (<i>r</i> = 0.38, <i>p</i> = 0.02) had reduced decisional conflict at posttest. Patients' and caregivers' agreement increased by 27.7% for an item assessing patients' preference for artificial nutrition and hydration (<i>p</i> = 0.03). <b><i>Conclusions:</i></b> This study suggests that collaborative ACP decision making may improve decisional conflict for older adult HH patients and their caregivers.