18-Month Sustainability of FACE®-TC Pediatric Advance Care Planning for Teens with Cancer: A Longitudinal Randomized Clinical Trial

• Published in: Journal of pain and symptom management 2022-05, Vol.63 (5), p.850-850
• Main Authors: Lyon, Maureen, Friebert, Sarah, Needle, Jennifer, Thompkins, Jessica, Grossoehme, Daniel, Baker, Justin
• Format: Article
• Language: English
• Subjects: Adolescents; Advance directives; Cancer; Care plans; Clinical medicine; Clinical research; Clinical trials; Congruence; Decision making; Efficacy; End of life decisions; Health care; Hospice care; Hospitals; Intervention; Pediatrics; Preferences; Sustainability; Teenagers; Treatment preferences
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2022.02.027

1. Explain the key principles of pediatric advance care planning 2. Appraise the value of FACE-TC approach to pediatric advance care planning 3. Evaluate FACE-TC approach to pediatric advance care planning The effect of pediatric advance care planning (pACP) interventions on sustainability of end-of-life treatment preference agreement between adolescents with cancer and their families is unstudied. To evaluate the longitudinal efficacy of a pACP intervention, FACE-TC, on the sustainability of end-of-life treatment preference agreement in adolescents with cancer and their families, compared to controls. This single-blinded, intent-to-treat randomized clinical trial assigned adolescents with cancer and family dyads to intervention or control groups. Participants were enrolled from four pediatric tertiary hospitals between July 2016 and April 2019. Intervention dyads received three 60-minute (FACE®-TC) sessions scheduled 1 week apart: (1) Lyon Family-Centered ACP Survey, (2) Next Steps: Respecting Choices interview, and (3) Five Wishes, advance directive. Control dyads received treatment as usual (TAU) plus advance care planning information. Congruence in end-of-life treatment preferences was measured by the Statement of Treatment Preferences in four cancer-specific situations immediately postintervention and at 3, 6, 12, and 18 months. A total of 126 dyads (252 participants) underwent 2:1 randomization (83 dyads to FACE®-TC and 43 to TAU). Regarding growth trajectory of congruence on end-of-life treatment preferences in cancer-specific situations in 12 months postintervention, adolescent/family dyads were classified into two unknown a priori groups (high vs. low congruence). The FACE®−TC intervention group had much higher odds (OR = 3.24; 95% CI, 1.09, 9.5) of being in the high-congruence group compared to controls. However, this effect became statistically insignificant at 18 months postintervention. Conversations matter. FACE®-TC families had 3 times the odds of more accurately reporting what their teen with cancer would want for end-of-life care, compared to controls up to 1 year postintervention. Research should examine strategies for implementation into clinical practice. FACE-TC deeply respects underserved adolescents by integrating them into healthcare decision making. Yearly booster sessions are optimal.