Effect of an App for Promoting Advance Care Planning and Motivating Patients to Write their Advance Directives

Abstract

Abstract Background We developed Accordons-nous, a smartphone app to support patients in the advance care planning (ACP) process. The app raises awareness and facilitates communication on this sensitive topic. It helps patients to express their values and preferences for care, and to write their advance directives (AD). Objective Measure the impact of distributing Accordons-nous, compared to the distribution of a leaflet, on common patients’ propensity to engage in an ACP process. Secondary objectives are to test the effect of socio-demographic factors (age, health state, gender, study level) on the propensity to engage in ACP. Methods Pre-post randomized control study. Participants were common patients approached in medical waiting rooms. They received the app (treatment) or an information leaflet (control) and responded to two questionnaires: one at recruitment and a second 2–4 weeks later. We measured improvement on four variables relevant to ACP: reported Contemplation of an event relevant to ACP, Decision about treatment in case of that event, Discussion about it with relatives or health care professionals, and Writing advance directives. Statistical analysis included between groups comparisons of pre-post differences with 2-sample tests for equality of proportions and logistic regression models. Results We recruited 473 participants and obtained full responses from 312. Overall the intervention (control and treatment together) affected positively the mean reported ACP engagement on all variables: new or renewed Contemplation 54%; increase in Decision + 8%, Discussion + 11%, and Writing + 1%, compared to the baseline. Compared to the control (leaflet), the treatment group (app) had a larger effect size on all variables: between groups difference in Contemplation + 11% (logistic regression, p = .05), Decision + 1% (but p = .94 on this variable), Discussion + 5% (p = .05), and Writing AD + 5% (p = 0.03). Moreover, increase in age is positively correlated with having written AD at inclusion (21% among retired compared to 2% among young adults) and with the propensity to write AD after our intervention (logistic regression, p = .001). Other factors tested (frequency of consultations, gender, level of education) had no effect on participants’ ACP engagement. Conclusions When distributed without specific counselling, our tool is efficient to increase reported ACP engagement although the effect sizes remain modest. Further studies are needed to investigate whether the app could profit more to ACP engagement when it is used by professionals in dedicated ACP consultations.