Advance Care Planning Affects End-of-Life Treatment Preferences Among Patients With Heart Failure: A Randomized Controlled Trial.

This study explored the effects of advance care planning interventions on end-of-life treatment decisions among patients with heart failure. The study design was a randomized controlled trial. An intervention involving a motivational video, a cartoon version educational brochure, and a guided discussion was implemented. A total of 82 hospitalized patients with heart failure were recruited. Half of the participants received the intervention, and the other half received routine care. The Life Support Preferences Questionnaire was the primary measurement instrument. Before the advance care planning intervention, a significant difference between the experimental and control groups was observed in the cardiopulmonary resuscitation score but not the total, antibiotics, surgery, and artificial nutrition and hydration scores. In the experimental group but not in the control group, significant differences were observed between pretest and posttest total, antibiotics, cardiopulmonary resuscitation, surgery, and artificial nutrition and hydration scores. Significant differences in mean score changes were observed in total and each treatment score between the experimental and control groups. The advance care planning intervention led participants to select fewer medical treatments. This intervention may be suitable for societies where people are unfamiliar with advance care planning and may feel uncomfortable discussing death.

Predictors of Quality of Life Change in Head-and-Neck Cancer Survivors during Concurrent Chemoradiotherapy: A Prospective Study.

OBJECTIVE: Head-and-neck cancer (HNC) and its treatment impact patients' quality of life (QoL) and survival. The symptom burden of HNC survivors severely affects QoL, while hope serves as an impetus for adjustment that enables survivors to sustain basic QoL. This study investigated the change of QoL, symptom burden, and hope and the predictors of QoL change in HNC survivors from diagnosis to 3 months after concurrent chemoradiotherapy (CCRT) completing. METHODS: This was a prospective, correlational study conducted between January 2016 and April 2017 at a medical center in northern Taiwan. Purposive sampling 54 adults newly diagnosed with HNC had completed the first CCRT. The questionnaires of Functional Assessment of Cancer Therapy-HNC Scale, M. D. Anderson Symptom Inventory, and Herth Hope Index were collected. The five measuring times were before CCRT (T1), the 3rd-4th week of CCRT (T2), the last week of CCRT (T3), and 1 month (T4) and 3 months (T5) after the completion of CCRT. RESULTS: The change of QoL first declined and then rose at T2-T5. The change of symptom burden increased initially and then declined at T2-T5. The change of hope remained steady between T1 and T5. The change of symptom burden and hope significantly predicted the change of QOL over time. CONCLUSIONS: Clinicians are suggested to assess symptom burden and hope regularly in HNC during their CCRT and, if needed, promptly provide interprofessional care in time. Reducing symptom burden and maintaining a mindful hope could improve QoL in HNC survivors during CCRT.