Gareth P Gilna, Justin Stoler, Rebecca A Saberi, Adriana C Baez, Walter A Ramsey, Carlos T Huerta, Christopher F O'Neil, Rishi Rattan, Eduardo A Perez, Juan E Sola, Chad M Thorson
Analyzing pediatric bicycle injuries using geo-demographic data
Journal of pediatric surgery
advance care planning acp remains low among patients advanced cancer multilevel interventions compared clinicianlevel interventions may effective improving acp evaluate whether multilevel intervention could improve cliniciandocumented acp compared clinicianlevel intervention alone randomized clinical trial performed september 12 2019 may 12 2021 included adults advanced genitourinary cancers academic tertiary hospital data analysis performed intention treat may 1 august 10 2023 participants randomized 11 6month patientlevel lay health worker structured acp education along clinicianlevel intervention composed 3hour acp training integration structured electronic health record documentation template intervention group clinicianlevel intervention alone control group primary outcome acp documentation electronic health record oncology clinician within 12 months randomization secondary exploratory outcomes included shared decisionmaking palliative care use hospice use emergency department visits hospitalizations within 12 months randomization among 402 participants enrolled study median age 71 years range 21102 years 361 898 identified male intervention group participants oncology cliniciandocumented acp control group participants 82 378 vs 40 216 odds ratio 229 95 ci 144364 12month followup intervention control group participants palliative care 72 332 vs 25 135 318 95 ci 191528 hospice use 49 226 vs 19 103 254 95 ci 144451 differences proportion participants groups emergency department visit 65 300 vs 61 330 087 95 ci 057133 hospitalization 89 410 vs 85 460 082 95 ci 055122 intervention group participants fewer hospitalizations control group participants mean sd number hospitalizations per year 087 160 vs 104 177 lower risk hospitalization incidence rate ratio 080 95 ci 065098 randomized clinical trial multilevel intervention improved oncology cliniciandocumented acp compared clinicianlevel intervention alone patients genitourinary cancer intervention one approach effectively increase acp among patients cancer clinicaltrialsgov identifier nct03856463