Integrating Advance Care Planning Videos into Surgical Oncologic Care: A Randomized Clinical Trial

Deconstructing the Complexities of Advance Care Planning Outcomes: What Do We Know and Where Do We Go? A Scoping Review

“…For Process outcomes, 21 of 29 (72%) were positive, including 20 of 27 (74%) for behavior change processes (e.g., readiness) ( Table 1). 17,23,46,92,101,126,127 For Action outcomes, 48 of 56 (86%) were positive, including seven of nine (78%) for patient reports of communication with surrogates 118,128 and clinicians 84,126,129 and 38 of 44 (86%) for ACP documentation. 17,80,120,125,127,130 For Quality of Care outcomes, 23 of 43 (53%) were positive.…”

“…None of the 10 quality-of-life outcomes were positive (0%). However, nine of 15 mental health outcomes were positive (60%), including two of seven (29%) for decreased patient anxiety and depression, 89,129 and seven of seven (100%) for surrogate depression, anxiety, posttraumatic stress disorder (PTSD), and complicated grief and caregiver burden. 46,62,86,97,135 One of one outcome was positive for reduction in clinician distress, 118 and one of four (25%) mortality outcomes showed improved survival.…”

A Multicenter, Randomized Controlled Trial of Perioperative Palliative Care Surrounding Cancer Surgery for Patients and Their Family Members (PERIOP-PC)

“…42 Indeed, multiple studies even document surgeon and surgical culture resistance to PC involvement, particularly any discussions that might concern end-of-life care. 43,[44][45][46][47][48][49][50] Informed by intense prior engagement and research with diverse patient, family, clinician, and researcher stakeholders, [51][52][53][54][55][56][57][58][59][60][61] our Patient-Centered Outcome Research Institute (PCORI)-funded study builds on the paucity of research regarding the impact of specialist PC on surgical oncologic patients and their family members. Addressing this important topic, we initiated a randomized clinical trial (the PERIOP-PC) trial; clinicaltrials.gov Identifier NCT03611309; PCORI: IHS 1609-36518).…”

“…This project builds on our previous PCORIfunded research developing and integrating video-based, advance care planning into the perioperative period for patients and families preparing for major cancer surgery (Refs. [51][52][53][54][55][56][57][58][59][60][61] ; clinicaltrials.gov Identifier NCT02489799; PCORI: CDR-12-11-4362). For PERIOP-PC, we hypothesize that surgeon-PC team co-management, as compared with surgeon-alone management, will improve quality of life for cancer patients at three months after the surgery (Hypothesis 1).…”

“…-An environmental scan with patient, family member, and clinician engagement to determine the ''state of the science'' for perioperative advance care planning 61 ; -Stakeholder summits with patients, family members, surgeons, PC clinicians, and researchers 55,57 ; -In-depth interviews and iterative engagement with perioperative patients, family members, the Johns Hopkins Hospital Patient and Family Advisory Council, and more than 70 different patients, family members, surgeons, PC clinicians, and other stakeholders 55 ; -A cross-sectional survey of 359 patients and/or family members from the lay public regarding perioperative PC issues and clarification of outcomes that patients and family members identify as important. A key outcome that they identified as important was that good perioperative care should include the opportunity for the patient and family to ''have a meaningful discussion with their doctor about their goals and wishes for surgery,'' which directly impacted our choice of perioperative PC in this clinical trial 52,53 ; -A systematic review of perioperative advance care planning aids 59 ; -Key informant interviews specifically about advance care planning and PC in surgery populations 60 ; -At-least monthly phone calls and co-publication with our patient/family co-investigators; -Close collaboration and co-publication with our surgeon co-investigators; -Development of a video-based advance care planning aid and testing of that aid in a clinical trial 51,58 ; -Clinical trial findings that patients and families found preoperative advance care planning ''helpful'' but that the video and patient/family activation did not change surgeon communication or behavior 51 ; and -Stakeholder summits after the clinical trial indicating that diverse stakeholders-particularly patients and family members-thought that preoperative advance care planning conversations should involve PC clinicians, rather than surgeons, and that PC practices (such as symptom management and psychosocial support) were likely to improve perioperative patient and family care.…”