Advance Care Planning

for Anxiety

Advance care planning is making decisions about care that a patient would want to receive, or not receive, if that patient becomes unable to speak for him or herself. Advance care planning activities provide support in decision-making about potentially limiting some medical interventions and establishing advance directives. Advance care planning was examined for its effect in reducing anxiety and depression for patients with cancer.

Research Evidence Summaries

Lyon, M.E., Jacobs, S., Briggs, L., Cheng, Y., Iris, & Wang, J. (2014). A longitudinal, randomized, controlled trial of advance care planning for teens with cancer: Anxiety, depression, quality of life, advance directives, spirituality. Journal of Adolescent Health, 54, 710–717.

DOI Link: doi: 10.1016/j.jadohealth.2013.10.206

Study Purpose

To test the feasibility, acceptability, and impact of family-centered advanced care planning for adolescents with cancer

Intervention Characteristics/Basic Study Process

Adolescent/family dyads were randomized to intervention and control study arms. All participants received a baseline assessment and were provided with an advanced care planning educational brochure. Those in the intervention group had five sessions of assessments and interviews and three weekly sessions with a trained or certified facilitator to explore values and beliefs, have conversations, share decision making processes about palliative care and goals, and express fears, values, beliefs, and goals about death and dying. Study measures were obtained at baseline and at three months.

Sample Characteristics

N = 30 patient/family dyads
MEAN PATIENT AGE = 16 years (range = 14–20 years)
MALES: 71%, FEMALES: 29%
KEY DISEASE CHARACTERISTICS: Leukemia, lymphoma, brain tumors, and other solid tumors; most were receiving cure-directed treatments; those with significant depression were excluded
OTHER KEY SAMPLE CHARACTERISTICS: 82% were in high school; 12% of families were at or below the federal poverty level; 41% were African American

Setting

SITE: Single site
SETTING TYPE: Multiple settings
LOCATION: Washington, DC

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care
APPLICATIONS: Pediatrics and palliative care

Study Design

Randomized, controlled trial

Measurement Instruments/Methods

Satisfaction questionnaire
Beck Anxiety Inventory (BAI)
Beck Depression Inventory (BDI)
Pediatric Quality of Life Inventory (PQLI)
Spiritual Well-Being Scale of the Functional Assessment of Cancer Therapy (FACT) scale

Results

Anxiety declined in all adolescents over time. Among families, anxiety declined in those in the control group but increased in families in the intervention group. Baseline depression was significantly lower in the intervention group and increased over time. There were no significant differences between groups from the group and time analysis. There were no significant differences between groups in quality of life results. There were no other differences based on group assignment.

Conclusions

The family-centered advance care planning intervention tested here did not demonstrate any benefits for patients or families in regard to anxiety, depression, or quality of life.

Limitations

Small sample (< 100)
Baseline sample/group differences of import
Risk of bias (no blinding)
Risk of bias (no appropriate attentional control condition)
Questionable protocol fidelity
Other limitations/explanation: No method to evaluate intervention fidelity was mentioned. There were significant differences between the groups in baseline anxiety and depression scores.

Nursing Implications

Advance care planning is an important component of care for patients with cancer and their families. However, it might not reduce the emotional effects of the cancer trajectory. This study had numerous limitations and did not find benefit in terms of reducing anxiety or depression. Additional well-designed studies are needed to confirm the findings shown here.

Effectiveness Not Established