Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial
Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. To test the implementation of ACP in...
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| Vydáno v: | PLoS medicine Ročník 17; číslo 11; s. e1003422 |
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| Hlavní autoři: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
Public Library of Science
13.11.2020
Public Library of Science (PLoS) |
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| ISSN: | 1549-1676, 1549-1277, 1549-1676 |
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| Abstract | Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce.
To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals.
Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed.
ISRCTN registry ISRCTN63110516. |
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| AbstractList | Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce.BACKGROUNDAdvance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce.To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals.METHODS AND FINDINGSTo test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals.Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed.CONCLUSIONSOur results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed.ISRCTN registry ISRCTN63110516.TRIAL REGISTRATIONISRCTN registry ISRCTN63110516. Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. Background Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. Methods and findings To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Conclusions Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. Trial registration ISRCTN registry ISRCTN63110516. Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. ISRCTN registry ISRCTN63110516. BackgroundAdvance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce.Methods and findingsTo test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals.ConclusionsOur results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed.Trial registrationISRCTN registry ISRCTN63110516. Giulia Carreras and colleagues report the implementation of advanced care planning in patients with advanced cancer. Background Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. Methods and findings To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015–2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0–3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients’ age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients’ quality of life did not differ between intervention and control groups (T-score −1.8 versus −0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Conclusions Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. Trial registration ISRCTN registry ISRCTN63110516. Background Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. Methods and findings To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015–2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0–3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients’ age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients’ quality of life did not differ between intervention and control groups (T-score −1.8 versus −0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Conclusions Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. Trial registration ISRCTN registry ISRCTN63110516. |
| Audience | Academic |
| Author | Caswell, Glenys Červ, Branka Groenvold, Mogens Toccafondi, Alessandro Carreras, Giulia Lunder, Urska Seymour, Jane Dunleavy, Lesley Thit Johnsen, Anna Billekens, Pascalle Miccinesi, Guido Gorini, Giuseppe Ingravallo, Francesca Arnfeldt Christensen, Caroline M. Bulli, Francesco Polinder, Suzanne Eecloo, Kim Wilcock, Andrew Hammes, Bud Verkissen, Mariëtte N. Simonič, Anja Preston, Nancy J. Bramley, Louise Jabbarian, Lea J. Pollock, Kristian van Delden, Johannes J. M. Deliens, Luc Kodba-Čeh, Hana Kars, Marijke C. van der Heide, Agnes Mimić, Alenka Briggs, Linda Korfage, Ida J. Payne, Sheila A. Rietjens, Judith A. C. Ozbič, Polona Zwakman, Marieke |
| AuthorAffiliation | 12 International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom UAB, UNITED STATES 4 Department of Palliative Medicine, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark 13 Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy 7 Respecting Choices, C-TAC Innovations, Oregon, Wisconsin, United States of America 6 Institute of Nursing and Midwifery Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom 14 Health Sciences School, University of Sheffield, Sheffield, United Kingdom 9 University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia 3 Department of Public Health, University of Copenhagen, Copenhagen, Denmark 1 Department of Public Health, Erasmus MC, Rotterdam, Netherlands 11 End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium 15 School of Medicine, University of Nottingham, Nottingham, Un |
| AuthorAffiliation_xml | – name: 6 Institute of Nursing and Midwifery Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom – name: 9 University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia – name: 15 School of Medicine, University of Nottingham, Nottingham, United Kingdom – name: UAB, UNITED STATES – name: 1 Department of Public Health, Erasmus MC, Rotterdam, Netherlands – name: 3 Department of Public Health, University of Copenhagen, Copenhagen, Denmark – name: 8 School of Health Sciences, University of Nottingham, Nottingham, United Kingdom – name: 7 Respecting Choices, C-TAC Innovations, Oregon, Wisconsin, United States of America – name: 13 Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy – name: 12 International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom – name: 4 Department of Palliative Medicine, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark – name: 11 End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium – name: 2 Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy – name: 14 Health Sciences School, University of Sheffield, Sheffield, United Kingdom – name: 5 Laurens, Rotterdam, Netherlands – name: 10 Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands |
| Author_xml | – sequence: 1 givenname: Ida J. orcidid: 0000-0001-6538-9115 surname: Korfage fullname: Korfage, Ida J. – sequence: 2 givenname: Giulia orcidid: 0000-0002-1427-637X surname: Carreras fullname: Carreras, Giulia – sequence: 3 givenname: Caroline M. surname: Arnfeldt Christensen fullname: Arnfeldt Christensen, Caroline M. – sequence: 4 givenname: Pascalle surname: Billekens fullname: Billekens, Pascalle – sequence: 5 givenname: Louise orcidid: 0000-0002-0425-1734 surname: Bramley fullname: Bramley, Louise – sequence: 6 givenname: Linda surname: Briggs fullname: Briggs, Linda – sequence: 7 givenname: Francesco surname: Bulli fullname: Bulli, Francesco – sequence: 8 givenname: Glenys orcidid: 0000-0002-8246-8189 surname: Caswell fullname: Caswell, Glenys – sequence: 9 givenname: Branka surname: Červ fullname: Červ, Branka – sequence: 10 givenname: Johannes J. M. orcidid: 0000-0002-5530-7275 surname: van Delden fullname: van Delden, Johannes J. M. – sequence: 11 givenname: Luc orcidid: 0000-0002-8158-2422 surname: Deliens fullname: Deliens, Luc – sequence: 12 givenname: Lesley surname: Dunleavy fullname: Dunleavy, Lesley – sequence: 13 givenname: Kim orcidid: 0000-0001-8743-866X surname: Eecloo fullname: Eecloo, Kim – sequence: 14 givenname: Giuseppe orcidid: 0000-0002-1413-5948 surname: Gorini fullname: Gorini, Giuseppe – sequence: 15 givenname: Mogens surname: Groenvold fullname: Groenvold, Mogens – sequence: 16 givenname: Bud orcidid: 0000-0001-5867-1577 surname: Hammes fullname: Hammes, Bud – sequence: 17 givenname: Francesca orcidid: 0000-0002-5194-375X surname: Ingravallo fullname: Ingravallo, Francesca – sequence: 18 givenname: Lea J. orcidid: 0000-0001-6418-162X surname: Jabbarian fullname: Jabbarian, Lea J. – sequence: 19 givenname: Marijke C. orcidid: 0000-0001-5680-4559 surname: Kars fullname: Kars, Marijke C. – sequence: 20 givenname: Hana surname: Kodba-Čeh fullname: Kodba-Čeh, Hana – sequence: 21 givenname: Urska orcidid: 0000-0002-0236-0240 surname: Lunder fullname: Lunder, Urska – sequence: 22 givenname: Guido orcidid: 0000-0002-7452-9594 surname: Miccinesi fullname: Miccinesi, Guido – sequence: 23 givenname: Alenka surname: Mimić fullname: Mimić, Alenka – sequence: 24 givenname: Polona surname: Ozbič fullname: Ozbič, Polona – sequence: 25 givenname: Sheila A. orcidid: 0000-0001-6982-9181 surname: Payne fullname: Payne, Sheila A. – sequence: 26 givenname: Suzanne surname: Polinder fullname: Polinder, Suzanne – sequence: 27 givenname: Kristian orcidid: 0000-0002-6836-8595 surname: Pollock fullname: Pollock, Kristian – sequence: 28 givenname: Nancy J. orcidid: 0000-0003-2659-2342 surname: Preston fullname: Preston, Nancy J. – sequence: 29 givenname: Jane orcidid: 0000-0002-9384-2551 surname: Seymour fullname: Seymour, Jane – sequence: 30 givenname: Anja orcidid: 0000-0002-1884-4522 surname: Simonič fullname: Simonič, Anja – sequence: 31 givenname: Anna orcidid: 0000-0003-0753-9634 surname: Thit Johnsen fullname: Thit Johnsen, Anna – sequence: 32 givenname: Alessandro surname: Toccafondi fullname: Toccafondi, Alessandro – sequence: 33 givenname: Mariëtte N. orcidid: 0000-0002-7797-5290 surname: Verkissen fullname: Verkissen, Mariëtte N. – sequence: 34 givenname: Andrew orcidid: 0000-0002-3214-1188 surname: Wilcock fullname: Wilcock, Andrew – sequence: 35 givenname: Marieke orcidid: 0000-0003-2934-8740 surname: Zwakman fullname: Zwakman, Marieke – sequence: 36 givenname: Agnes surname: van der Heide fullname: van der Heide, Agnes – sequence: 37 givenname: Judith A. C. surname: Rietjens fullname: Rietjens, Judith A. C. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33186365$$D View this record in MEDLINE/PubMed |
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| Title | Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial |
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