Projeto e teste de uma ferramenta baseada na Web para a melhoria do planejamento de fim de vida em pacientes com câncer avançado

Patients receive Peacefully's web-based tool to help with end-of-life planning on day 7.

Ancillary studies

Receive Peacefully's end-of-life planning program

Patients receive standard care.

Ancillary studies

Receive standard of care

• padrão de atendimento
• terapia padrão

Will be measured using a 14-item checklist of all completed tasks from the checklists/tasks on the website (eg, gather important documents, create a will). Scores are computed by summing together the total number of planning items completed. Scores can range from 0 to 14, with higher scores indicating increases in completion of end-of-life planning tasks. Change scores can range from -14 to +14.

Will be measured using a 14-item checklist of all completed tasks from the checklists/tasks on the website (eg, gather important documents, create a will). Scores are computed by summing together the total number of planning items completed. Scores can range from 0 to 14, with higher scores indicating increases in completion of end-of-life planning tasks. Change scores can range from -14 to +14.

Will be measured using a 14-item checklist of all completed tasks from the checklists/tasks on the website (eg, gather important documents, create a will). Scores are computed by summing together the total number of planning items completed. Scores can range from 0 to 14, with higher scores indicating increases in completion of end-of-life planning tasks. Change scores can range from -14 to +14.

Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Decision Maker (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around advance care planning (e.g., "Have you already decided who you want your medical decision maker to be?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning. Change scores can range from -4 to +4.

Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Decision Maker (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around advance care planning (e.g., "Have you already decided who you want your medical decision maker to be?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning. Change scores can range from -4 to +4.

Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Decision Maker (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around advance care planning (e.g., "Have you already decided who you want your medical decision maker to be?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning. Change scores can range from -4 to +4.

Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Quality of Life (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around quality of life in advance care planning (e.g., "Have you already decided whether or not certain health situations would make your life not worth living?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning as it pertains to quality of life. Change scores can range from -4 to +4.

Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Quality of Life (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around quality of life in advance care planning (e.g., "Have you already decided whether or not certain health situations would make your life not worth living?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning as it pertains to quality of life. Change scores can range from -4 to +4.

Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Quality of Life (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around quality of life in advance care planning (e.g., "Have you already decided whether or not certain health situations would make your life not worth living?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning as it pertains to quality of life. Change scores can range from -4 to +4.

Engagement in ACP with family members/loved ones and doctors will be assessed in patients. This outcome will consist of documentation of ACP conversations using the investigators' previously utilized 8-item measure of discussing EoL care, living will, HCP, and DNR orders with family (4 items) and doctors (4 items). Scores for the subscale are computed by summing together the total number of ACP topic discussed with the patient's family members/loved ones and doctors. Scores can range from 0 to 8, with higher scores indicating increases in engagement in ACP conversations with family members/loved ones and doctors. Change scores can range from -8 to +8.

Engagement in ACP with family members/loved ones and doctors will be assessed in patients. This outcome will consist of documentation of ACP conversations using the investigators' previously utilized 8-item measure of discussing EoL care, living will, HCP, and DNR orders with family (4 items) and doctors (4 items). Scores for the subscale are computed by summing together the total number of ACP topic discussed with the patient's family members/loved ones and doctors. Scores can range from 0 to 8, with higher scores indicating increases in engagement in ACP conversations with family members/loved ones and doctors. Change scores can range from -8 to +8.

Engagement in ACP with family members/loved ones and doctors will be assessed in patients. This outcome will consist of documentation of ACP conversations using the investigators' previously utilized 8-item measure of discussing EoL care, living will, HCP, and DNR orders with family (4 items) and doctors (4 items). Scores for the subscale are computed by summing together the total number of ACP topic discussed with the patient's family members/loved ones and doctors. Scores can range from 0 to 8, with higher scores indicating increases in engagement in ACP conversations with family members/loved ones and doctors. Change scores can range from -8 to +8.

Completion of advance directives will be assessed by asking patients whether they completed a do-not-resuscitate order, a living will, and/or identified a health care proxy; data will be verified through the patient's electronic health record. Change in these numbers will be assessed at baseline and post-intervention. Scores are computed by summing together the total number of advance directives completed. Scores can range from 0 to 3, with higher scores indicating increases in completion of advance directives. Change scores can range from -3 to +3.

Completion of advance directives will be assessed by asking patients whether they completed a do-not-resuscitate order, a living will, and/or identified a health care proxy; data will be verified through the patient's electronic health record. Change in these numbers will be assessed at baseline and post-intervention. Scores are computed by summing together the total number of advance directives completed. Scores can range from 0 to 3, with higher scores indicating increases in completion of advance directives. Change scores can range from -3 to +3.

Completion of advance directives will be assessed by asking patients whether they completed a do-not-resuscitate order, a living will, and/or identified a health care proxy; data will be verified through the patient's electronic health record. Change in these numbers will be assessed at baseline and post-intervention. Scores are computed by summing together the total number of advance directives completed. Scores can range from 0 to 3, with higher scores indicating increases in completion of advance directives. Change scores can range from -3 to +3.

Anxiety will be measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), a valid and reliable 7-item, Likert-type self-report measure of mood disturbance commonly used with cancer patients. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a HADS-A total score. Total scores can range from 0 to 21, with higher numbers indicating higher levels of anxiety. Change in anxiety will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -21 to +21.

Anxiety will be measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), a valid and reliable 7-item, Likert-type self-report measure of mood disturbance commonly used with cancer patients. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a HADS-A total score. Total scores can range from 0 to 21, with higher numbers indicating higher levels of anxiety. Change in anxiety will be assessed at baseline and post-randomization. Change scores can range from -21 to +21.

Anxiety will be measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), a valid and reliable 7-item, Likert-type self-report measure of mood disturbance commonly used with cancer patients. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a HADS-A total score. Total scores can range from 0 to 21, with higher numbers indicating higher levels of anxiety. Change in anxiety will be assessed at baseline and post-randomization. Change scores can range from -21 to +21.

Psychological Distress will be measured using the Center for Epidemiological Studies Depression Scale (CESD), a valid and reliable 20-item, Likert-type self-report measure of frequency and severity of depressive symptoms over the previous week. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a total score. Total scores can range from 0 to 60, with higher numbers indicating higher levels of psychological distress. Change in psychological distress will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -60 to +60.

Psychological Distress will be measured using the Center for Epidemiological Studies Depression Scale (CESD), a valid and reliable 20-item, Likert-type self-report measure of frequency and severity of depressive symptoms over the previous week. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a total score. Total scores can range from 0 to 60, with higher numbers indicating higher levels of psychological distress. Change in psychological distress will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -60 to +60.

Psychological Distress will be measured using the Center for Epidemiological Studies Depression Scale (CESD), a valid and reliable 20-item, Likert-type self-report measure of frequency and severity of depressive symptoms over the previous week. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a total score. Total scores can range from 0 to 60, with higher numbers indicating higher levels of psychological distress. Change in psychological distress will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -60 to +60.

Emotional and social well-being will be measured using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale. The FACT-G scale contains 27 items that ask patients to rate the degree to which they agree to statements about their well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating better well-being. Total scores can range from 0-108. Change in emotional and social well-being will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -108 to +108.

Emotional and social well-being will be measured using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale. The FACT-G scale contains 27 items that ask patients to rate the degree to which they agree to statements about their well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating better well-being. Total scores can range from 0-108. Change in emotional and social well-being will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -108 to +108.

Emotional and social well-being will be measured using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale. The FACT-G scale contains 27 items that ask patients to rate the degree to which they agree to statements about their well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating better well-being. Total scores can range from 0-108. Change in emotional and social well-being will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -108 to +108.

Spiritual well-being will be measured using the validated, 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The FACIT-Sp asks patients to indicate the degree to which they agree with statements about their spiritual well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating greater spiritual well-being. Total scores range from 0 to 48. Change in spiritual well-being will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -48 to +48.

Spiritual well-being will be measured using the validated, 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The FACIT-Sp asks patients to indicate the degree to which they agree with statements about their spiritual well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating greater spiritual well-being. Total scores range from 0 to 48. Change in spiritual well-being will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -48 to +48.

Spiritual well-being will be measured using the validated, 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The FACIT-Sp asks patients to indicate the degree to which they agree with statements about their spiritual well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating greater spiritual well-being. Total scores range from 0 to 48. Change in spiritual well-being will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -48 to +48.

Financial well-being will be measured using the validated, 8-item InCharge Financial Distress/Financial Well-Being scale. This scale asks patients to rate their financial wellness (stress, satisfaction, etc.) on a 10-point Likert scale that varies for each response but for which 1 indicates the lowest financial well-being and 10 indicates the highest (e.g., 1=overwhelming stress to 10 = not stress at all; 1 = worry all the time, 10 - never worry). Total scores range from 8 to 80, with higher scores indicating greater financial well-being. Change in financial well-being will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -72 to +72.

Financial well-being will be measured using the validated, 8-item InCharge Financial Distress/Financial Well-Being scale. This scale asks patients to rate their financial wellness (stress, satisfaction, etc.) on a 10-point Likert scale that varies for each response but for which 1 indicates the lowest financial well-being and 10 indicates the highest (e.g., 1=overwhelming stress to 10 = not stress at all; 1 = worry all the time, 10 - never worry). Total scores range from 8 to 80, with higher scores indicating greater financial well-being. Change in financial well-being will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -72 to +72.

Financial well-being will be measured using the validated, 8-item InCharge Financial Distress/Financial Well-Being scale. This scale asks patients to rate their financial wellness (stress, satisfaction, etc.) on a 10-point Likert scale that varies for each response but for which 1 indicates the lowest financial well-being and 10 indicates the highest (e.g., 1=overwhelming stress to 10 = not stress at all; 1 = worry all the time, 10 - never worry). Total scores range from 8 to 80, with higher scores indicating greater financial well-being. Change in financial well-being will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -72 to +72.