TY - JOUR
T1 - Advance care planning does not adversely affect hope or anxiety among patients with advanced cancer
AU - Green, Michael
AU - Schubart, Jane R.
AU - Whitehead, Megan M.
AU - Farace, Elana
AU - Lehman, Erik
AU - Levi, Benjamin
N1 - Funding Information:
This work was supported by Grant #RSGHP-08-005-01-CPHPS , “End-of-Life Health Care Decisions by Patients with Advanced Cancer,” from the American Cancer Society .
Publisher Copyright:
© 2015 American Academy of Hospice and Palliative Medicine.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Context Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. Objectives To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Methods Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. Results A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P < 0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P < 0.01) in the Intervention than Control group. Conclusion Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being.
AB - Context Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. Objectives To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Methods Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. Results A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P < 0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P < 0.01) in the Intervention than Control group. Conclusion Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being.
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U2 - 10.1016/j.jpainsymman.2014.11.293
DO - 10.1016/j.jpainsymman.2014.11.293
M3 - Article
C2 - 25542552
AN - SCOPUS:84931956635
SN - 0885-3924
VL - 49
SP - 1088
EP - 1096
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 6
ER -
