Background Uptake of advance care planning (ACP) in cancer remains poor. An emphasis on personal values discussions and adoption of novel interventions may serve as the catalyst to increase engagement. This study examined the effectiveness of a Video Decision Support Tool (VDST) modelling values conversations in cancer ACP.
Methods This single site, open-label, randomised controlled trial allocated patient-caregiver dyads on a 1:1 ratio to VDST or usual care (UC). Previously used written vignettes were converted to video vignettes using recommended methodology. We evaluated ACP completion rates, understanding and perspectives on ACP, congruence in communication and preparation for decision-making.
Results Participants numbered 113 with a 60.4% response rate. The VDST did not improve overall ACP completion (37.7% VDST; 36.7% UC). However, the VDST improved ACP completion in older patients (≥70) compared to younger counterparts (<70) (OR=0.308, 95% CI: 0.096, 0.982, p=0.047), elicited greater distress in patients (p=0.015) and improved opportunities for patients and caregivers to discuss ACP with their health professionals. ACP improved concordance in communication (VDST p=0.006; UC p=0.045), more so with the VDST (Effect size: VDST 0.7; UC 0.54). Concordance in communication also improved in both arms with age.
Conclusion Receptivity towards ACP in cancer patients may be enhanced with novel approaches that focus on exploring core patient values, with the aim of achieving concordance in communication in families through shared recognition of these values. Striving for more meaningful outcomes may be the catalyst needed to progress ACP towards a more fulfilling process for those who partake in it.