Nurse-led advance care planning with older people who have end-stage kidney disease: feasibility of a deferred entry randomised controlled trial incorporating an economic evaluation and mixed methods process evaluation (ACReDiT)

BMC Nephrology

Mike Clarke¹  Christopher Cardwell¹  Fliss Murtagh²  Karan Shah³  Rachael Morton³  Joanne Shields⁴  Robert Mullan⁵  Peter Maxwell⁶  Trisha Forbes⁷  Helen Noble⁷  Kevin Brazil⁷  Peter O’Halloran⁷  Michael Matthews⁸  Kelly Norwood⁹ 

[1] Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences, Royal Victoria Hospital, BT12 6BA, Belfast, UK;Hull York Medical School, University of Hull, Allam Medical Building, HU6 7RX, Hull, UK;NHMRC Clinical Trials Centre, University of Sydney, Medical Foundation Building, 92-94 Parramatta Rd, 2050, Camperdown, NSW, Australia;Regional Nephrology Unit, Belfast City Hospital, 51 Lisburn Road, BT9 7AB, Belfast, UK;Renal Unit, Antrim Area Hospital, Bush Road, BT41 2RL, Antrim, UK;School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Whitla Medical Building, 97 Lisburn Road, BT9 7BL, Belfast, UK;Regional Nephrology Unit, Belfast City Hospital, 51 Lisburn Road, BT9 7AB, Belfast, UK;School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, BT9 7BL, Belfast, UK;School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, BT9 7BL, Belfast, UK;Renal Unit, Antrim Area Hospital, Bush Road, BT41 2RL, Antrim, UK;School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA, Co. Londonderry, UK;

关键词: Advance care planning;    Advance directives;    End-of-life care;    End-stage Kidney disease;    Feasibility studies;    Palliative care;    Randomized controlled trial;    Renal Dialysis;   

DOI  :  10.1186/s12882-020-02129-5

来源: Springer

【 摘 要 】

BackgroundAdvance Care Planning is recommended for people with end-stage kidney disease but evidence is limited. Robust clinical trials are needed to investigate the impact of advance care planning in this population. There is little available data on cost-effectiveness to guide decision makers in allocating resources for advance care planning. Therefore we sought to determine the feasibility of a randomised controlled trial and to test methods for assessing cost-effectiveness.MethodsA deferred entry, randomised controlled feasibility trial, incorporating economic and process evaluations, with people with end-stage kidney disease, aged 65 years or older, receiving haemodialysis, in two renal haemodialysis units in Northern Ireland, UK. A nurse facilitator helped the patient make an advance care plan identifying: a surrogate decision-maker; what the participant would like to happen in the future; any advance decision to refuse treatment; preferred place of care at end-of-life.ResultsRecruitment lasted 189 days; intervention and data collection 443 days. Of the 67 patients invited to participate 30 (45%) declined and 36 were randomised to immediate or deferred advance care plan groups. Twenty-two (61%) made an advance care plan and completed data collection at 12 weeks; 17 (47.2%) were able to identify a surrogate willing to be named in the advance care plan document. The intervention was well-received and encouraged end-of-life conversations, but did not succeed in helping patients to fully clarify their values or consider specific treatment choices. There was no significant difference in health system costs between the immediate and deferred groups.ConclusionsA trial of advance care planning with participants receiving haemodialysis is feasible and acceptable to patients, but challenging. A full trial would require a pool of potential participants five times larger than the number required to complete data collection at 3 months. Widening eligibility criteria to include younger (under 65 years of age) and less frail patients, together with special efforts to engage and retain surrogates may improve recruitment and retention. Traditional advance care planning outcomes may need to be supplemented with those that are defined by patients, helping them to participate with clinicians in making medical decisions.Trial registrationRegistered December 16, 2015. ClinicalTrials.gov Identifier: NCT02631200.

【 授权许可】

CC BY