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BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial

BACKGROUND: Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal. OBJECTIVE: Assess a comprehensive, person-centred ACP approach. DESIGN: Unblinded, cluster randomised tri...

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Autores principales: Garland, Allan, Keller, Heather, Quail, Patrick, Boscart, Veronique, Heyer, Michelle, Ramsey, Clare, Vucea, Vanessa, Choi, Nora, Bains, Ikdip, King, Seema, Oshchepkova, Tatiana, Kalashnikova, Tatiana, Kroetsch, Brittany, Steer, Jessica, Heckman, George
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946666/
https://www.ncbi.nlm.nih.gov/pubmed/35325020
http://dx.doi.org/10.1093/ageing/afac049
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author Garland, Allan
Keller, Heather
Quail, Patrick
Boscart, Veronique
Heyer, Michelle
Ramsey, Clare
Vucea, Vanessa
Choi, Nora
Bains, Ikdip
King, Seema
Oshchepkova, Tatiana
Kalashnikova, Tatiana
Kroetsch, Brittany
Steer, Jessica
Heckman, George
author_facet Garland, Allan
Keller, Heather
Quail, Patrick
Boscart, Veronique
Heyer, Michelle
Ramsey, Clare
Vucea, Vanessa
Choi, Nora
Bains, Ikdip
King, Seema
Oshchepkova, Tatiana
Kalashnikova, Tatiana
Kroetsch, Brittany
Steer, Jessica
Heckman, George
author_sort Garland, Allan
collection PubMed
description BACKGROUND: Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal. OBJECTIVE: Assess a comprehensive, person-centred ACP approach. DESIGN: Unblinded, cluster randomised trial. SETTING: Fourteen control and 15 intervention NHs in three Canadian provinces, 2018–2020. SUBJECTS: 713 residents (442 control, 271 intervention) aged ≥65 years, with elevated mortality risk. METHODS: The intervention was a structured, [Formula: see text] 60-min discussion between a resident, substitute decision-maker (SDM) and nursing home staff to: (i) confirm SDMs’ identities and role; (ii) prepare SDMs for medical emergencies; (iii) explain residents’ clinical condition and prognosis; (iv) ascertain residents’ preferred philosophy to guide decision-making and (v) identify residents’ preferred options for specific medical emergencies. Control NHs continued their usual ACP processes. Co-primary outcomes were: (a) comprehensiveness of advance care planning, assessed using the Audit of Advance Care Planning, and (b) Comfort Assessment in Dying. Ten secondary outcomes were assessed. P-values were adjusted for all 12 outcomes using the false discovery rate method. RESULTS: The intervention resulted in 5.21-fold higher odds of respondents rating ACP comprehensiveness as being better (95% confidence interval [CI] 3.53, 7.61). Comfort in dying did not differ (difference = −0.61; 95% CI −2.2, 1.0). Among the secondary outcomes, antimicrobial use was significantly lower in intervention homes (rate ratio = 0.79, 95% CI 0.66, 0.94). CONCLUSIONS: Superior comprehensiveness of the BABEL approach to ACP underscores the importance of allowing adequate time to address all important aspects of ACP and may reduce unwanted interventions towards the end of life.
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spelling pubmed-89466662022-03-28 BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial Garland, Allan Keller, Heather Quail, Patrick Boscart, Veronique Heyer, Michelle Ramsey, Clare Vucea, Vanessa Choi, Nora Bains, Ikdip King, Seema Oshchepkova, Tatiana Kalashnikova, Tatiana Kroetsch, Brittany Steer, Jessica Heckman, George Age Ageing Research Paper BACKGROUND: Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal. OBJECTIVE: Assess a comprehensive, person-centred ACP approach. DESIGN: Unblinded, cluster randomised trial. SETTING: Fourteen control and 15 intervention NHs in three Canadian provinces, 2018–2020. SUBJECTS: 713 residents (442 control, 271 intervention) aged ≥65 years, with elevated mortality risk. METHODS: The intervention was a structured, [Formula: see text] 60-min discussion between a resident, substitute decision-maker (SDM) and nursing home staff to: (i) confirm SDMs’ identities and role; (ii) prepare SDMs for medical emergencies; (iii) explain residents’ clinical condition and prognosis; (iv) ascertain residents’ preferred philosophy to guide decision-making and (v) identify residents’ preferred options for specific medical emergencies. Control NHs continued their usual ACP processes. Co-primary outcomes were: (a) comprehensiveness of advance care planning, assessed using the Audit of Advance Care Planning, and (b) Comfort Assessment in Dying. Ten secondary outcomes were assessed. P-values were adjusted for all 12 outcomes using the false discovery rate method. RESULTS: The intervention resulted in 5.21-fold higher odds of respondents rating ACP comprehensiveness as being better (95% confidence interval [CI] 3.53, 7.61). Comfort in dying did not differ (difference = −0.61; 95% CI −2.2, 1.0). Among the secondary outcomes, antimicrobial use was significantly lower in intervention homes (rate ratio = 0.79, 95% CI 0.66, 0.94). CONCLUSIONS: Superior comprehensiveness of the BABEL approach to ACP underscores the importance of allowing adequate time to address all important aspects of ACP and may reduce unwanted interventions towards the end of life. Oxford University Press 2022-03-23 /pmc/articles/PMC8946666/ /pubmed/35325020 http://dx.doi.org/10.1093/ageing/afac049 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Research Paper
Garland, Allan
Keller, Heather
Quail, Patrick
Boscart, Veronique
Heyer, Michelle
Ramsey, Clare
Vucea, Vanessa
Choi, Nora
Bains, Ikdip
King, Seema
Oshchepkova, Tatiana
Kalashnikova, Tatiana
Kroetsch, Brittany
Steer, Jessica
Heckman, George
BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial
title BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial
title_full BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial
title_fullStr BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial
title_full_unstemmed BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial
title_short BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial
title_sort babel (better targeting, better outcomes for frail elderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946666/
https://www.ncbi.nlm.nih.gov/pubmed/35325020
http://dx.doi.org/10.1093/ageing/afac049
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