To determine whether an ACP intervention enables patients with cancer to receive care at the End of Life (EoL) consistent with their preferences.
Patients with incurable cancer, and a Family Member (FM), were randomised one-to-one to usual care or usual care plus an ACP intervention, between April 2014 and January 2017. Oncologists and participants were non-blinded. Participants were recruited from seven Australian metropolitan oncology centres. ACP was based on the Respecting Patient Choices model, with an offer of individualised typical, best-case and worst-case scenarios for expected survival time. 79 patients and 53 FMs attended an ACP discussion. The primary outcome measure, assessed by interview 3 months after patient death, was FM perception that the patient’s wishes were discussed, and met.
665 patients were referred by oncologists, 444 (66.8%) met the study inclusion criteria and were approached by a study researcher. 208 patients (46.8%) and their FM entered the trial as dyads. 53 (46%) dyads in the ACP group and 63 (54%) dyads in the usual care group had complete primary outcome data (p=0.16). FMs from 23 (43%) ACP and 21 (33%) usual care dyads reported the patient’s EoL wishes were discussed and met (difference = 10%, 95% CI:-2, 8, p = 0.27). There were no differences in EoL care received, patient satisfaction with care; FM satisfaction with care or with death; or FM well-being. Rates of palliative care referral were high in both groups (97% versus 96%).
Conclusions and Relevance:
A formal ACP intervention provided no added benefit in cancer care where a cultural shift towards non-aggressive interventions at the EoL and routine palliative care referral has already occurred.
Australia and New Zealand Clinical Trials Registry ACTRN1261300128871.