1. Effect of the STAMP (Sharing and Talking About My Preferences) Intervention on Completing Multiple Advance Care Planning Activities in Ambulatory Care : A Cluster Randomized Controlled Trial.
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Fried, Terri R., Paiva, Andrea L., Redding, Colleen A., Iannone, Lynne, O'Leary, John R., Zenoni, Maria, Risi, Megan M., Mejnartowicz, Slawomir, and Rossi, Joseph S.
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CLUSTER randomized controlled trials ,OUTPATIENT medical care ,SCHEDULING ,LIFE course approach ,ADVANCE directives (Medical care) ,ADULTS ,RESEARCH ,FERRANS & Powers Quality of Life Index ,RESEARCH methodology ,MEDICAL cooperation ,EVALUATION research ,COMPARATIVE studies ,RANDOMIZED controlled trials ,BLIND experiment ,RESEARCH funding ,PAMPHLETS - Abstract
Background: Interventions with the potential for broad reach in ambulatory settings are necessary to achieve a life course approach to advance care planning.Objective: To examine the effect of a computer-tailored, behavioral health model-based intervention on the engagement of adults in advance care planning recruited from ambulatory care settings.Design: Cluster randomized controlled trial with participant-level analysis. (ClinicalTrials.gov: NCT03137459).Setting: 10 pairs of primary and selected specialty care practices matched on patient sociodemographic information.Participants: English-speaking adults aged 55 years or older; 454 adults at practices randomly assigned to usual care and 455 at practices randomly assigned to intervention.Intervention: Brief telephone or web-based assessment generating a mailed, individually tailored feedback report with a stage-matched brochure at baseline, 2 months, and 4 months.Measurements: The primary outcome was completion of the following 4 advance care planning activities at 6 months: identifying and communicating with a trusted person about views on quality versus quantity of life, assignment of a health care agent, completion of a living will, and ensuring that the documents are in the medical record-assessed by a blinded interviewer. Secondary outcomes were completion of individual advance care planning activities.Results: Participants were 64% women and 76% White. The mean age was 68.3 years (SD, 8.3). The predicted probability of completing all advance care planning activities in usual care sites was 8.2% (95% CI, 4.9% to 11.4%) versus 14.1% (CI, 11.0% to 17.2%) in intervention sites (adjusted risk difference, 5.2 percentage points [CI, 1.6 to 8.8 percentage points]). Prespecified subgroup analysis found no statistically significant interactions between the intervention and age, education, or race.Limitations: The study was done in a single region and excluded non-English speaking participants. No information was collected about nonparticipants.Conclusion: A brief, easily delivered, tailored print intervention increased participation in advance care planning in ambulatory care settings.Primary Funding Source: National Institute of Nursing Research and National Institute of Aging. [ABSTRACT FROM AUTHOR]- Published
- 2021
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