title: A randomized, controlled trial to improve advance care planning among patients undergoing cardiac surgery.
abstract: BACKGROUND
  Although many healthcare providers and researchers consider it necessary to assist patients with end-stage chronic illnesses to plan for the end of life, they tend to avoid discussing end-of-life issues with patients before major surgery. Consequently, surgical patients and their families generally have insufficient knowledge to make plans in case of life-threatening complications.
  
  
  OBJECTIVE
  The objective of this study was to evaluate short-term effects of Patient-Centered Advance Care Planning (PC-ACP).
  
  
  METHODS
  Thirty-two dyads of patients undergoing cardiac surgery and their surrogates were randomly assigned to receive either the PC-ACP intervention (PC-ACP) or usual care.
  
  
  METHODS
  Measures studied were patient-surrogate congruence regarding goals for future medical care, patient and surrogate knowledge of advance care planning and anxiety, and patient decisional conflict. Congruence and anxiety were measured before and after the intervention. Decisional conflict and knowledge of advance care planning were measured after the intervention.
  
  
  RESULTS
  Compared with the control group, PC-ACP significantly improved patient-surrogate congruence (Delta=1.27, P<0.01) and reduced patients' decisional conflict (Delta=-0.77, P<0.05). Anxiety change (pre/post) did not differ between treatment and control groups. No difference in knowledge of advance care planning was found between the 2 groups.
  
  
  CONCLUSIONS
  The PC-ACP can be an effective approach to advance care planning. Its specificity and relevance to patients' actual medical conditions (as exemplified by its plans for potential complications related to cardiac surgery) can lead to greater patient-surrogate congruence without increasing decisional conflict and anxiety.
authors.affiliation: Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania 15261, USA. songm@pitt.edu
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Song
authors.forename: Karin T
authors.initials: KT
authors.lastname: Kirchhoff
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Douglas
authors.forename: Sandra
authors.initials: S
authors.lastname: Ward
authors.forename: Bernard
authors.initials: B
authors.lastname: Hammes
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration / Q000592:standards*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000523:psychology; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009723:Nurse-Patient Relations; D010358:Patient Participation; D018802:Patient-Centered Care; D019727:Proxy; D011785:Quality Assurance, Health Care / Q000379:methods*