2022 Fiscal Year Final Research Report
Is prognostication useful as a trigger for advance care planning? A randomised controlled trial.
| Project/Area Number |
19K22760
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| Research Category |
Grant-in-Aid for Challenging Research (Exploratory)
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| Allocation Type | Multi-year Fund |
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| Review Section |
Medium-sized Section 58:Society medicine, nursing, and related fields
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| Research Institution | University of Tsukuba (2022)
Kobe University (2019-2021) |
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Principal Investigator |
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| Co-Investigator(Kenkyū-buntansha) |
森田 達也 聖隷クリストファー大学, 看護学研究科, 臨床教授 (70513000)
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| Project Period (FY) |
2019-06-28 – 2023-03-31
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| Keywords | アドバンス・ケア・プランニング / 予後予測 / 緩和ケア / ランダム化比較試験 |
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| Outline of Final Research Achievements |
The aim of this study was to examine, using a randomised controlled trial, whether presenting accurate prognostic predictions using objective measures improves the willingness of ACPs to discuss them. Physicians currently treating cancer were randomly selected into two groups: the control group was given a subjective prognosis for their patients, while the intervention group was given an objective prognostic estimate (50% chance of survival at 56 days and 70% at 28 days). 223 physicians participated in the study. The willingness of the intervention group to implement ACP was 96.5%, compared with 94.3% of the control group. There was also no significant difference in the willingness of the two groups to determine a surrogate decision-maker. The results of this study show that informing doctors about objective prognostic predictions does not lead to an increase in doctors' willingness to implement ACP.
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| Free Research Field |
緩和ケア
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| Academic Significance and Societal Importance of the Research Achievements |
本研究の結果からは、精度の高い予後予測を提示することは、ACP実施に対する意欲を変化させないことが示唆される。ACPの実践をすすめる為には、話し合いに対する患者のバリアを下げる努力（例：予め話し合われる内容を開示する）、両者が安全に話し合いができる環境の整備（例：話し合いの意欲がある患者を予め選択しておく）、医師に対する話し合いの方法の教育（コミュニケーションスキルトレーニングなど）が有効な可能性があり、今後これらを用いた研究の実施が必要である。
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