Family-centered advanced care planning benefits ailing teens

Maureen E. Lyon, Ph.D., from Children's National Medical Center in Washington, D.C., and colleagues randomized 60 adolescents (mean age of 16 years; 60 percent male; 50 percent white; and 43 percent black) with cancer to receive either three 60-minute sessions one week apart of family-centered ACP or standard care plus information. Those in the intervention group completed the Lyon Family-Centered ACP Survey, the Respecting Choices interview, and the Five Wishes directive. Decisional Conflict Scale scores and treatment preferences were evaluated in all.

The researchers found that patient diagnoses included leukemia (47 percent), brain tumor (27 percent), solid tumor (20 percent), and lymphoma (7 percent). Among the intervention dyads there was significantly increased congruence compared to the controls for four of six disease-specific scenarios, including one in which treatment would extend life by not more than two to three months. All adolescents in the intervention group wanted their families to do what was best at the time, compared to only 62 percent of teens in the control group. There was significantly better knowledge about end-of-life decisions in the intervention teens, and intervention families were more likely to agree on limiting treatment than controls.

"Advance care planning enabled families to understand and honor their adolescents' wishes," the authors write.

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Journal reference: JAMA Pediatrics

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