A Pilot Randomized Trial of an Advance Care Planning Video Decision Support Tool for Adolescents and Young Adults With Advanced Cancer

Authors:
Jennifer M. Snaman Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts

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Deborah Feifer Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts

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Gabrielle Helton University of Colorado School of Medicine, Aurora, Colorado

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Yuchiao Chang Massachusetts General Hospital, Boston, Massachusetts

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Areej El-Jawahri Massachusetts General Hospital, Boston, Massachusetts

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Angelo E. Volandes Massachusetts General Hospital, Boston, Massachusetts

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Joanne Wolfe Massachusetts General Hospital, Boston, Massachusetts

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Background: Adolescents and young adults (AYAs) with advanced cancer often receive intensive end-of-life care, yet it is unclear if this is goal-concordant. Advance care planning (ACP) video tools may promote identification and communication of AYA preferences. Patients and Methods: We conducted a dual-site, 1:1 pilot randomized controlled trial of a novel video-based ACP tool in 50 dyads of AYA patients aged 18 to 39 years with advanced cancer and their caregivers. ACP readiness and knowledge, preferences for future care, and decisional conflict were obtained pre, post, and 3 months after the intervention and compared between groups. Results: Of the 50 AYA/caregiver dyads enrolled, 25 (50%) were randomized to the intervention. Participants primarily identified as female, white, and non-Hispanic. Most AYAs (76%) and caregivers (86%) identified their overall goal as life-prolonging preintervention; less identified this goal postintervention (42% AYAs; 52% caregivers). There was no significant difference in change in proportion of AYAs or caregivers choosing life-prolonging care, CPR, or ventilation between arms postintervention or at 3 months. The change in participant scores for ACP knowledge (AYAs and caregivers) and ACP readiness (AYAs) from preintervention to postintervention was greater in the video arm compared with the control arm; the difference in caregivers’ scores for decisional conflict from preintervention to postintervention in the video arm was statistically significant (15 vs 7; P=.005). Feedback from the video participants was overwhelmingly positive; of the 45 intervention participants who provided video feedback, 43 (96%) found the video helpful, 40 (89%) were comfortable viewing the video, and 42 (93%) indicated they would recommend the video to other patients facing similar decisions. Conclusions: Most AYAs with advanced cancer and their caregivers preferred life-prolonging care in advanced illness, with fewer preferring this type of care postintervention. A brief video-based ACP tool was well-liked by participants and improved caregiver decisional certainty. Videos may be a useful tool to inform AYAs and caregivers about end-of-life care options and promote ACP discussions.

Submitted January 25, 2023; final revision received March 12, 2023; accepted for publication March 13, 2023.

Author contributions: Study concept and design: Snaman, El-Jawahri, Volandes, Wolfe. Data acquisition: Snaman, Feifer, Helton. Data analysis and interpretation: All authors. Writing—original draft: Snaman, Feifer, Helton. Critical revision: Feifer, Helton, Chang, El-Jawahri, Volandes, Wolfe.

Disclosures: Dr. Volandes has disclosed having a financial interest in ACP Decisions. Dr. El-Jawahri has disclosed serving as a consultant for Novartis, Incyte, and GlaxoSmithKline. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number 1R21CA234708-01A1 (A.E. Volandes).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Correspondence: Jennifer M. Snaman, MD, MS, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215. Email: jennifer_snaman@dfci.harvard.edu

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