Assessing the efficacy and cost-effectiveness of targeted advance care planning interventions among patients with severe respiratory disease in a tertiary hospital and in a rural setting

This trial investigated whether a nurse-led approach to advance care planning was helpful for people diagnosed with serious respiratory disease, and their family members. 149 participants were recruited into this trial. Participants were invited to give consent for random allocation to the intervention group (nurse-led advance care planning) or usual care group. However if they had strong preferences to receive (or not receive) the intervention, participants were allocated to their preferred group. 67 participants were randomly allocated (45 to the intervention and 22 to the usual care group). 61 participants strongly preferred to receive the intervention, and were allocated as such. 21 participants strongly preferred to not receive the intervention, and were allocated to the usual care group. Participants allocated to receive the intervention had a higher likelihood of having completed formal advance care planning documents at six month follow up (51%) compared to those allocated to usual care (14%). Those in the intervention group were also more likely to have had advance care planning discussions with their doctor (72%) than those allocated to usual care (47%). Those with more severe symptoms and those with a pre-existing preference to be allocated to the intervention were more likely to undertake advance care planning. Those with higher social support (i.e. more support from close family and friends) were more likely to discuss advance care planning with their loved ones.