A Novel Website to Prepare Diverse Older Adults for Decision Making and Advance Care Planning: A Pilot Study

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• 作者：Rebecca L. Sudore ; MD^a ; ^b ; ^{rebecca.sudore@ucsf.edu" class="auth_mail} ; Sara J. Knight ; PhD^c ; ^e ; Ryan D. McMahan ; BS ; BA^a ; ^b ; Mariko Feuz ; BS^a ; ^b ; David Farrell ; MPH^f ; Yinghui Miao ; MPH^a ; ^b ; Deborah E. Barnes ; PhD ; MPH^a ; ^c ; ^d
• 关键词：Advance care planning ; medical decision making ; aging ; technology
• 刊名：Journal of Pain and Symptom Management
• 出版年：April, 2014
• 年：2014
• 卷：47
• 期：4
• 页码：674-686
• 全文大小：337 K

文摘

Context

We have reconceptualized advance care planning (ACP) as a multistep process focused on preparing patients with skills needed for communication and in-the-moment decision making.

Objectives

To operationalize this paradigm, we created an easy-to-use ACP website () based on a theoretical framework of behavior change and pilot-tested its efficacy to engage older adults in ACP.

Methods

At baseline and 1聽week after viewing the PREPARE website, we assessed behavior change in ACP by using a validated survey that includes Process Measures (knowledge, contemplation, self-efficacy, and readiness, 5-point Likert scales) and Action Measures (yes/no whether an ACP behavior was completed). We also assigned participants into behavior change stages (i.e., precontemplation, contemplation, preparation, action, maintenance) and determined the percentage of participants who moved from precontemplation at baseline to higher stages at 1聽week. We also assessed PREPARE ease-of-use (10-point scale, 10 being the easiest). Changes were assessed with Wilcoxon signed rank sum tests and McNemar鈥檚 tests.

Results

Mean age of the participants was 68.4聽years (SD 6.6), and 65% were nonwhite. Behavior Change Process Measures average Likert scores increased from 3.1 (0.9) to 3.7 (0.7), P聽<聽0.001. Action Measures did not change significantly. However, precontemplation significantly decreased for most actions (e.g., talking to doctor about desired medical care, 61% to 35%, P聽<聽0.003), with a mean decrease of 21% (range, 16%-33%). PREPARE was rated a nine of ten (卤1.9) for ease-of-use.

Conclusion

A new, patient-centered ACP website that focuses on preparing patients for communication and decision making significantly improves engagement in the process of ACP and behavior change. A clinical trial of PREPARE is currently underway.