{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:53:47Z","timestamp":1791428027700,"version":"4.3.3"},"reference-count":48,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"10","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncol Pract"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Guidelines recommend advance care planning (ACP) to improve patient-centered care near the end of life (EOL), but the optimal approach is unknown. This single-blind, patient-level, randomized comparative effectiveness trial compared two patient-facing ACP interventions that are widely used but differ in costs and complexity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Adult patients with advanced solid tumors and their caregivers were recruited from academic and community oncology clinics. Participants were randomly assigned to facilitated ACP using trained nurse facilitators versus patient-directed ACP using written and web-based tools. The primary outcome was patient-reported ACP engagement (assessed at baseline and 12 weeks using a 15-item validated survey; range, 0-5; higher scores indicate higher engagement). Secondary outcomes included advance directive completion and communication about EOL wishes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A total of 400 patients enrolled (mean [SD] age, 67.9 [10.5] years; 192 women [48%]). At 12 weeks, patients in the facilitated versus patient-directed group reported higher ACP engagement (4.34 [0.78]\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      4.08 [0.82]; adjusted mean difference, 0.25 [95% CI, 0.1 to 0.4];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0014) and higher odds of completing an advance directive (74.8%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      60.6%; OR, 2.52 [95% CI, 1.27 to 5.0];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .008). There were no significant differences between the facilitated and patient-directed groups in the odds of having a conversation about EOL wishes with family or friends (88.9%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      88%; OR, 1.13 [95% CI, 0.5 to 2.6];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .76) or physicians (49.6%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      40.6%; OR, 1.53 [95% CI, 0.9 to 2.7];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .13), and all ACP behaviors increased significantly from baseline in both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Facilitated ACP resulted in greater increases in ACP engagement and advance directive completion than patient-directed written and web-based materials. Although some patients with advanced cancer may engage in self-directed ACP, some may need additional facilitator support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/op-25-00046","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T15:59:15Z","timestamp":1742399955000},"page":"1447-1457","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":7,"title":["Facilitated Versus Patient-Directed Advance Care Planning Among Patients With Advanced Cancer: A Randomized Clinical Trial"],"prefix":"10.1200","volume":"21","clinical-trial-number":[{"clinical-trial-number":"nct03824158","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1307-9988","authenticated-orcid":true,"given":"Yael","family":"Schenker","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA"},{"name":"Palliative Research 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