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Background: There are multiple companies that manufacture cochlear implants available for patient use. Currently, the Cochlear Implant Clinic at St. Paul's Hospital uses primarily one manufacturer, and patients do not have the opportunity to choose a particular manufacturer during the decision process. Using the latest models there is no evidence to show that there is superiority with any one particular manufacturer when comparing hearing results post-implantation. Adding choice could potentiate patient anxiety, however, there are other centres that do offer choices to patients with evidence to show that there is high patient satisfaction with this model as well. Objectives: • To determine if patients at our centre wish to have a choice and participate in the selection of their cochlear implant manufacturer • To gather and evaluate patient experiences with the current pre-operative cochlear implant decision process at our centre Methods: Thirty semi-structured qualitative one-on-one interviews will be conducted to evaluate patient choice and preferences when it comes to deciding on a particular cochlear implant manufacturer. Both pre-operative CI candidates and post-operative patients are allowed to participate. Transcripts of the interviews will undergo qualitative analysis tools, including coding and thematic analysis. Results: Qualitative analysis of the data currently suggests that many patients do not place large emphasis on the manufacturer or brand of cochlear implant, as long as the decision is supported by the cochlear implant team. Conclusions: At this time, there may not necessarily be significant advances in patient satisfaction by allowing patients to select the manufacturer of their cochlear implant. When it came to the decision process, patients felt more empowered selecting a device that matched their personal preferences and lifestyle, which correlates more to the specific model of the implant, as opposed to the particular brand or manufacturer. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce., Methods and Findings: To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals., Conclusions: Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed., Trial Registration: ISRCTN registry ISRCTN63110516., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: BH and LB are developers of Respecting Choices and report personal fees from Gundersen Health, outside the submitted work.