Authors (including presenting author) :
Lau FSY
Affiliation :
Department of Medicine & Therapeutics, Prince of Wales Hospital
Introduction :
Chronic obstructive pulmonary disease (COPD) is an irreversible progressive disease. The symptoms include severe shortness of breath and decline in function status along the disease trajectory. Mechanical ventilation is often given to patients with advanced COPD during acute exacerbation. However, some studies found that patients were distressed when they received non-invasive ventilation (NIV) . Besides, patients with advanced COPD had poor psychological status during end-of-life care. Therefore, it is vital to engage this group of patients in their treatment decision to prevent decisional conflict during their late stages. Advance care planning supports individuals make decision about their future medical care and respect their right to choice . Video-decision aid could be effective in enhancing their health literacy in the process of end-of-life decision-making. Therefore, we hypothesised that an evidence-based video-decision aid could be an effective tool to improve knowledge and decisional conflicts about end-of-life care among patients with advanced COPD.
Objectives :
The aim of this pilot study was to develop an evidence-based video decision aid about NIV for patients with advanced COPD. The objectives were to test the feasibility of this evidence-based video decision-aid.
Methodology :
This pilot randomised controlled trial study included two phases. Phase 1 was a systematic review with meta-analysis and Phase 2 phase was a two-arm single-blinded randomised controlled trial (RCT). According to the systematic review, an evidence-based video-decision regarding non-invasive ventilation among patients with advanced COPD was developed. Patients with advanced COPD were recruited from four medical wards of Prince of Wales Hospital and randomly assigned into control group and intervention group. The intervention group received the programme “You have a choice” that included a 3-minute decision-aid video and an information booklet, while the control group received usual care. The recruitment, retention and the adherence rates were measured to access the feasibility of this study. The acceptability of the intervention was assessed by using a satisfaction survey and their qualitative comments. The study outcomes included decisional conflict about end-of-life care measured by the SURE test and the 9-item ACP engagement at 1-month (T1), 3-month (T2), and 6-month (T3) after the group allocation. Reasons of drop out were explored. The process of analysis was followed the intention to treat principle. All the statistical data was analysed by using SPSS version 30.0.
Result & Outcome :
A total of 123 patients were screened from January 2024 to June 2024. Of them,113 patients were eligible (91%) but 53 patients refused to participate in the study due to personal reasons (62%), resistance to discussing end-of-life issues (17%), family rejection (14%), and worry for extra follow-up (6%). Finally, 60 patients (mean age 79.13 (SD 9.2) years; 100% male) consented to participate. The attrition rate at T1, T2 and T3 were 23.3%, 31.7% and 51.7%, respectively. The intervention group reported significantly higher scores for the SURE score at T1, T2 and T3 than the control group (ps < 0.001).
In the self-efficacy of the ACP engagement, the intervention group had significant better self-efficacy at T1, T2 and T3 (p< 0.001) compared with control group.
In the satisfaction survey, the average satisfaction score was 4.73 out of 6. 96% of the participants found the intervention acceptable. Most of them would recommend it to other patients with COPD.
Conclusions: Our findings showed that most of the advanced COPD and their family were resistant to plan for end-of-life care. This evidence-based video decision aid significantly reduced decisional conflicts about end-of-life care and improved readiness for advance care planning among patients with advanced COPD. More efforts should be given to patient education about the prognosis in the early stage of disease trajectory.
