Development and pilot of an advance care planning website for women with ovarian cancer: a randomized controlled trial

Abstract

Objective: Few available tools facilitate cancer patients and physicians' discussions of quality of life and end-of-life. Our objective was to develop a web-based tool to promote advance care planning for women with ovarian cancer.

Methods: Women with ovarian cancer, their families, clinicians and researchers met to identify ways to improve cancer care. A prototype website was created to address advance care planning, focusing on advance healthcare directives (AHD) and palliative care consultation. Patients were recruited from a gynecologic oncology clinic for a pilot randomized controlled trial. Primary outcomes included completion of an AHD and palliative care consultation.

Results: At study completion, 53 women with ovarian cancer were enrolled and 35 completed the study. The mean age at enrollment was 57.9 ± 9.5 years; most were newly diagnosed or at first recurrence. There were no statistical differences in completion of AHD (p=0.220) or palliative care consultation (p=0.440) between intervention and control groups. However, women in the intervention group showed evidence of moving toward decision making regarding AHD and palliative care and lower decisional conflict. Women assigned to the intervention, compared to control website, were highly satisfied with the amount (p=0.054) and quality (p=0.119) of information and when they accessed the website, used it longer (p=0.049). Overall website use was lower than expected, resulting from several patient-related and design barriers.

Conclusions: A website providing information and decisional support for women with ovarian cancer is feasible. Increasing frequency of website use requires future research.

Keywords: Education; End of life; Ovarian cancer; Quality-of-life; Website.

Conflict of interest statement

Conflict of interest statement: None of the authors declare a conflict of interest.

© 2013.

Figures

Fig. 1

Example screenshots of intervention website.

Fig. 2

Enrollment and randomization of women with ovarian cancer. Flow of subjects through study.

Fig. 3

Decision-making by study group among completers. Decisions surrounding (a) completion of an Advance Healthcare Directive (AHD) and (b) Palliative Care Consultation are presented pre and post-study by randomization group. The circles and solid lines represent the intervention group and the squares and dotted lines represent the control group.