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. 2020 Sep 20;10(9):e037144.
doi: 10.1136/bmjopen-2020-037144.

Nurse-led patient-centred intervention to increase written advance directives for outpatients in early-stage palliative care: study protocol for a randomised controlled trial with an embedded explanatory qualitative study

Katia Iglesias  1 , Catherine Busnel  2 , Florian Dufour  3 , Sophie Pautex  4 , Laurence Séchaud  5
Affiliations

Nurse-led patient-centred intervention to increase written advance directives for outpatients in early-stage palliative care: study protocol for a randomised controlled trial with an embedded explanatory qualitative study

Katia Iglesias et al. BMJ Open. .

Abstract

Introduction: Discussing the evolution of life-threatening diseases and end-of-life issues remains difficult for patients, relatives and professionals. Helping people discuss and formalise their preferences in end-of-life care, as planned in the Go Wish intervention, could reduce health-related anxiety in the advance care planning (ACP) and advance directive (AD) process. The aims of this study are (1) to test the effectiveness of the Go Wish intervention among outpatients in early-stage palliative care and (2) to understand the role of defence mechanisms in end-of-life discussions among nurses, patients and relatives.

Methods and analysis: A mixed-methods study will be performed. A cluster randomised controlled trials with three parallel arms will be conducted with 45 patients with chronic progressive diseases impacting life expectancy in each group: (1) Group A, Go Wish intervention for patients and their relatives; (2) Group A, Go Wish intervention for patients alone and (3) Group B, for patients (with a waiting list), who will receive the standardised information on ADs (usual care). Randomisation will be at the nurse level as each patient is referred to one of the 20 participating nurses (convenience sample of 20 nurses). A qualitative study will be conducted to understand the cognitive and emotional processes and experiences of nurses, patients and relatives confronted with end-of-life discussions. The outcome measurements include the completion of ADs (yes/no), anxiety, quality of communication about end-of-life care, empowerment, quality of life and attitudes towards ADs.

Ethics and dissemination: The study protocol has been approved by the Human Research Ethics Committee of the Canton of Geneva, Switzerland (no. 2019-00922). The findings will be disseminated to practice (nurses, patients and relatives), to national and international scientific conferences, and peer-reviewed journals covering nursing science, psychology and medicine.

Trial registration number: NCT04065685.

Keywords: adult palliative care; public health; qualitative research.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Procedure for nurses of groups A and B. (A): Go Wish tool; (B): usual care: standardised information on advance directives. Colours: (1) blue; nurses as participants of the study, (2) red; nurse’s appointments with patients and relatives depending on the group and (3) green; after the study.
Figure 2
Figure 2
Procedure for the patients and relatives of groups A and B. (A): Go Wish tool; (B): usual care: standardised information on advance directives.
See this image and copyright information in PMC

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