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Title: Fidelity is fundamental: intervention predictors in advance care plans in terminal cancer.
Austin Authors: Vaccaro, Lisa;Butow, Phyllis N;Lee, Deborah;Johnson, Stephanie B;Bell, Melanie;Clayton, Josephine;Detering, Karen M ;Tattersall, Martin
Affiliation: Department of Medical Oncology, University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, New South Wales, Australia
Centre for Learning & Research in Palliative Care, Hammond Care, Greenwich Hospital and University of Sydney, Sydney, New South Wales, Australia
Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
Nuffield Department of Population Health, Wellcome Centre for Ethics and Humanities and Ethox Centre, University of Oxford, Oxford, UK
Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
Issue Date: Dec-2019
Date: 2019-09-19
Publication information: BMJ supportive & palliative care 2019; 9(4): 397-403
Abstract: Assessing whether interventions are implemented as intended (fidelity) is critical to establishing efficacy in clinical research yet rarely applied in advance care planning (ACP) interventions. We aimed to develop and implement a fidelity audit tool for an ACP intervention. We developed a fidelity audit tool assessing: (A) content; (B) quality (general communication, eliciting EOL preferences and prognostic communication); and (C) family/caregiver involvement. We audited (double-coded) 55 audio-recordings of ACP discussions delivered to advanced cancer patients and caregivers, within a clinical trial. Fidelity to content was high: mean=9.38/11 but lower for the quality of general communication (mean=12.47/20), discussion of patient preferences (mean=4.67/7), prognosis (mean=3.9/6) and family/caregiver involvement (mean=2.67/4). Older patient age and caregiver religiosity were associated with higher fidelity. Higher fidelity to content was associated with the trial primary outcome of family caregiver report of patient wishes being discussed and met. Fidelity to content, but not quality, of the ACP intervention is strong. Communication skills training is critical for ACP interventionists. Adherence was higher with older patients and religious carers, factors that may influence acceptance of death and readiness to undertake ACP, making the discussion easier. ACTRN12613001288718.
DOI: 10.1136/bmjspcare-2019-001917
ORCID: 0000-0001-6166-5442
Journal: BMJ supportive & palliative care
PubMed URL: 31537578
Type: Journal Article
Subjects: Intervention fidelity
advance care planning
Appears in Collections:Journal articles

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