ImportanceThe long-term effect of interventions that assist patients with establishing their end-of-life care preferences among patients with cancer remain relatively unknown.ObjectiveTo evaluate the association of a long-term intervention of a lay health worker–led advance care planning intervention among patients with advanced stages of cancer with overall survival and end-of-life health care use and costs.Design, Setting, and ParticipantsThis follow-up study of the EPAC randomized clinical trial conducted between August 2013 and February 2015 used data from 9.4 years after the first patient was enrolled with a data cut-off date of February 1, 2023. Overall, 213 participants with stage 3 or 4 or recurrent cancer in the US Veterans Affairs Palo Alto Health Care System were included.InterventionsA 6-month lay health worker–led education and support intervention to assist patients with establishing their end-of-life preferences vs usual care.Main Outcomes and MeasuresThe outcomes of interest were overall survival, risk of death, restricted mean survival time, and palliative care, hospice, and acute care use in the final 30 days before death for participants who died.ResultsAmong 213 participants randomized and included in the intention-to-treat analysis, the mean (SD) age was 69.3 (9.1) years; 211 (99.1%) were male, 2 (0.90%) were female. There were no demographic or clinical characteristic imbalances at enrollment. As of February 1, 2023, 188 had died. The intervention group had a 25% reduction in risk of death (hazard ratio, 0.75; 95% CI, 0.56-0.98); more palliative care (44 [50.0%] vs 35 [35.0%]) and hospice use (64 [72.7%] vs 53 [53.0%]); and lower emergency department use (20 [22.7%] vs 47 [47.0%]), hospitalizations (17 [19.3%] vs 46 [46.0%]), and median (IQR) total health care costs (median [IQR], $1637 [$383-$9026] vs $18 520 [$4790-$50 729]) than control group participants.Conclusions and RelevanceThe effects of the lay health worker–led intervention remain durable, with nearly complete follow-up, supporting integration into routine cancer care.Trial RegistrationClinicalTrials.gov Identifier: NCT02966509

中文翻译：

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晚期癌症患者的长期参与


重要性在癌症患者中帮助患者建立临终护理偏好的干预措施的长期效果仍然相对未知。目的评估由非专业卫生工作者主导的预先护理计划干预措施的长期干预与癌症患者之间的关系晚期癌症患者的总体生存率和临终医疗保健的使用和费用。设计、设置和参与者这项 EPAC 随机临床试验的后续研究于 2013 年 8 月至 2015 年 2 月期间进行，使用了 9.4 年后的数据第一个患者的数据截止日期为 2023 年 2 月 1 日。总体而言，美国退伍军人事务部帕洛阿尔托医疗保健系统中的 213 名患有 3 期或 4 期癌症或复发性癌症的参与者被纳入其中。 干预措施 一名为期 6 个月的非专业卫生工作者–主导的教育和支持干预，以帮助患者确定他们的临终偏好与常规护理。主要结果和措施感兴趣的结果是总生存率、死亡风险、限制平均生存时间以及姑息治疗、临终关怀和急性治疗死亡参与者在死亡前最后 30 天的护理使用情况。 结果 在随机分组并纳入意向治疗分析的 213 名参与者中，平均 (SD) 年龄为 69.3 (9.1) 岁；男性 211 人（99.1%），女性 2 人（0.90%）。入组时不存在人口统计学或临床特征失衡。截至 2023 年 2 月 1 日，已有 188 人死亡。干预组的死亡风险降低了 25%（风险比，0.75；95% CI，0.56-0.98）；更多姑息治疗（44 [50.0%] vs 35 [35.0%]）和临终关怀服务（64 [72.7%] vs 53 [53.0%]）；急诊科使用率（20 [22.7%] vs 47 [47.0%]）、住院率（17 [19.3%] vs 46 [46.0%]）较低。0%]) 和中位数 (IQR) 总医疗保健费用（中位数 [IQR]，1637 美元 [383-9026 美元] vs 18 520 美元 [4790-50 729 美元]）高于对照组参与者。结论和相关性非专业卫生工作者的影响–主导的干预措施仍然持久，随访几乎完整，支持纳入常规癌症护理。试验注册临床试验。政府标识符：NCT02966509