Overbeek A, et al. - The effectiveness of advance care planning (ACP) in frail older adults was analyzed in this cluster randomized controlled trial. Researchers reported that ACP did not increase levels of patient activation or quality of life. However, it increases completion of advance directives (ADs) and appointment of surrogate decision-makers. They did not find differences in the use of medical care.

Methods

• This trial was conducted at residential care homes in the Netherlands (N=16).
• Study participants were care home residents and community-dwelling adults receiving home care (N=201; n=101 intervention; n=100 control).
• Participants in the study were 75 years and older, frail, and capable of consenting to cooperation.
• Adjusted Respecting Choices ACP program was the main intervention in this analysis.
• Change in patient activation (Patient Activation Measure, PAM-13) between baseline and 12-month follow-up was the primary outcome.
• Change in quality of life (SF-12), AD completion, and surrogate decision-maker appointment were the included secondary outcomes.
• In addition, use of medical care in the 12 months after inclusion was evaluated.
• Researchers performed multilevel analyses, controlling for clustering effects and differences in demographics.

Results

• For this study, 77 intervention participants and 83 controls completed the follow-up assessment.
• No statistically significant differences were found 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.
• It was observed that 93% completed an AD and 94% appointed a decision-maker of intervention group participants.
• In addition, 34% completed an AD and 67% appointed a decision-maker (p < .001) of control participants.
• They found no differences in the use of medical care.