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著者: Anouk Overbeek, Ida J Korfage, Lea J Jabbarian, Pascalle Billekens, Bernard J Hammes, Suzanne Polinder, Johan Severijnen, Siebe J Swart, Frederika E Witkamp, Agnes van der Heide, Judith A C Rietjens
雑誌名: J Am Geriatr Soc. 2018 Jul;66(6):1089-1095. doi: 10.1111/jgs.15333. Epub 2018 Apr 2.
Abstract/Text
OBJECTIVES: To determine the effectiveness of advance care planning (ACP) in frail older adults. DESIGN: Cluster randomized controlled trial. SETTING: Residential care homes in the Netherlands (N=16). PARTICIPANTS: Care home residents and community-dwelling adults receiving home care (N=201; n=101 intervention; n=100 control). Participants were 75 years and older, frail, and capable of consenting to participation. INTERVENTION: Adjusted Respecting Choices ACP program. MEASUREMENTS: The primary outcome was change in patient activation (Patient Activation Measure, PAM-13) between baseline and 12-month follow-up. Secondary outcomes included change in quality of life (SF-12), advance directive (AD) completion, and surrogate decision-maker appointment. Use of medical care in the 12 months after inclusion was also assessed. Multilevel analyses were performed, controlling for clustering effects and differences in demographics. RESULTS: Seventy-seven intervention participants and 83 controls completed the follow-up assessment. There were no statistically significant differences between the intervention (-0.26±11.2) and control group (-1.43±10.6) in change scores of the PAM (p=.43) or the SF-12. Of intervention group participants, 93% completed an AD, and 94% appointed a decision-maker. Of control participants, 34% completed an AD, and 67% appointed a decision-maker (p<.001). No differences in the use of medical care were found. CONCLUSIONS: ACP did not increase levels of patient activation or quality of life but did increase completion of ADs and appointment of surrogate decision-makers. It did not affect use of medical care.
© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.
PMID 29608789 J Am Geriatr Soc. 2018 Jul;66(6):1089-1095. doi: 10.1111/jgs.15333. Epub 2018 Apr 2.
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