Promoting advance planning for health care and research among older adults: A randomized controlled trial
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- 作者：Gina Bravo (1) (2)
Marcel Arcand (2) (3)
Danièle Blanchette (2) (4)
Anne-Marie Boire-Lavigne (3)
Marie-France Dubois (1) (2)
Maryse Guay (1)
Paule Hottin (5)
Julie Lane (1) (6)
Judith Lauzon (7)
Suzanne Bellemare (2) - 刊名：BMC Medical Ethics
- 出版年：2012
- 出版时间：December 2012
- 年：2012
- 卷：13
- 期：1
- 全文大小：289KB
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89. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6939/13/1/prepub - 作者单位：Gina Bravo (1) (2)
Marcel Arcand (2) (3)
Danièle Blanchette (2) (4)
Anne-Marie Boire-Lavigne (3)
Marie-France Dubois (1) (2)
Maryse Guay (1)
Paule Hottin (5)
Julie Lane (1) (6)
Judith Lauzon (7)
Suzanne Bellemare (2)
1. Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
2. Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada
3. Department of Family Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
4. Department of Accounting Sciences and Taxation, Faculty of Business Administration, University of Sherbrooke, Sherbrooke, QC, Canada
5. Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
6. Department of Coordination and Academic Affairs, Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada
7. Member of the Québec Bar, Province of Quebec, Canada
文摘
Background Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/Design Dyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments. Discussion This study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system. Trial Registration ISRCTN89993391