A feasibility trial of advance care planning for patients with terminal cancer in primary hospitals

TL;DR

This study shows that advance care planning in primary hospitals can reduce anxiety and depression in terminal cancer patients and caregivers, while improving quality of life and reducing medical costs.

Contribution

The study demonstrates the feasibility and benefits of implementing advance care planning in primary hospitals for terminal cancer patients.

Findings

Caregivers in the ACP group had significantly lower anxiety and depression two weeks post-intervention.

ACP improved quality of life dimensions like role functioning, pain, and nausea/vomiting.

ACP reduced ICU admissions, hospital stay length, and direct medical costs.

Abstract

To investigate the effects of advance care planning (ACP) on patients with terminal cancer in primary hospitals.

Convenience sampling was used to select 60 patients with terminal cancer and their primary caregivers from primary hospitals. The control group received routine care, while the intervention group received routine care plus an ACP-based care intervention. Patients and their primary caregivers’ anxiety and depression levels were assessed before and after the intervention. We compared several outcomes between the ACP intervention and routine care control group, including quality of life scores (EORTC QLQ-C30), frequency of intensive care unit (ICU) admissions, length of hospital stay within 30 days before death, and direct medical costs.

Two weeks post-intervention, caregivers’ anxiety and depression were significantly lower in the ACP group than in the control group (P < 0.05). The ACP group also showed significant improvements in quality of life, including role functioning, pain, nausea/vomiting, dyspnea, constipation, diarrhea. At 1 month post-intervention, both patients and caregivers had significantly reduced anxiety/depression in the ACP group (P < 0.05). All quality-of-life dimensions significantly improved with ACP (P < 0.05). There were also significant reductions in ICU admission frequency, length of hospital stay within 30 days before death, and direct medical costs in the ACP group relative to the control group (P < 0.05).

ACP intervention can be successfully implemented for patients with terminal cancer in primary hospitals when clinicians receive structured training and standardized documentation and family engagement protocols are followed. Furthermore, the findings suggest that ACP may help reduce anxiety and depression in patients and their caregivers, improve patients’ quality of life, and has the potential to decrease ICU admissions, hospital stay length, and direct medical costs.

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