The Web-Based Advance Care Planning Program "Explore Your Preferences for Treatment and Care": Development, Pilot Study, and Before-and-After Evaluation

Doris van der Smissen*, Judith A.C. Rietjens, Sandra van Dulmen, Ton Drenthen, F. Ragnhild M.D. Vrijaldenhoven-Haitsma, Marijke Wulp, Agnes van der Heide, Ida J. Korfage

*Corresponding author for this work

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Abstract

BACKGROUND: Web-based advance care planning (ACP) programs may support patients in thinking about and discussing their preferences for future treatment and care. However, they are not widely available, and only a limited number of programs are evidence based. OBJECTIVE: We aimed to develop and evaluate an evidence-based, interactive web-based ACP program that guides users through the process of thinking about, discussing, and recording of preferences for treatment and care. METHODS: The program "Explore your preferences for treatment and care" was developed, pilot-tested on feasibility, and subsequently evaluated; engagement in ACP was assessed before program completion and 2 months after program completion using the ACP Engagement Survey (score 1-5) among 147 persons with chronic disease. Usability (score 0-100) and user satisfaction (score 1-5) were also assessed. RESULTS: ACP engagement increased from 2.8 before program completion to 3.0 two months after program completion (P<.001); contemplation about ACP increased from 2.6 to 2.8 (P=.003), and readiness for ACP increased from 2.2 to 2.5 (P<.001). No changes were found for knowledge about ACP (3.0-3.2; P=.07) and self-efficacy for ACP (3.8-3.8; P=.25). The program was perceived as usable (mean 70, SD 13), attractive (mean 3.8, SD 0.7), and comprehensible (mean 4.2, SD 0.6). CONCLUSIONS: We developed an evidence-based, interactive web-based ACP program in cocreation with patients, relatives, and health care professionals. Before-and-after evaluation showed that the program can support people in taking first steps in ACP and in reflecting on preferences for treatment and care, by guiding them through the process of ACP using a stepwise approach. Participants perceived the program as usable and understandable, and they were satisfied with the program and with the amount of information. Health care professionals may use the program as a tool to start ACP discussions with their patients. The program may increase awareness of ACP.

Original languageEnglish
Article numbere38561
JournalJournal of Medical Internet Research
Volume24
Issue number12
DOIs
Publication statusPublished - 2 Dec 2022

Bibliographical note

Funding Information:
This work was supported by the Netherlands Organisation for Health Research and Development (grant 80-84400-98-356). The funding source had no involvement in the study design, collection, analysis, and interpretation of data, in the writing of the report and in the decision to submit the paper for publication.

Funding Information:
The authors would like to thank the members of the stakeholder group for their contribution to the development of the web-based ACP program: the contributing patients and relatives, the Dutch College of General Practitioners (Nederlands Huisartsen Genootschap), the Dutch Association for Kidney Patients (Nierpatiënten Vereniging Nederland), the Dutch Association for Patients (de Nederlandse Patiëntenvereniging), Agora (organization to promote the palliative approach), Nivel (the Netherlands institute for health services research), the University of Twente, and Vital Innovators. The authors would also like to thank all participants for participating in this study and the Netherlands Organization for Health Research and Development for the funding. This work was supported by the Netherlands Organisation for Health Research and Development (grant 80-84400-98-356). The funding source had no involvement in the study design, collection, analysis, and interpretation of data, in the writing of the report and in the decision to submit the paper for publication.

Publisher Copyright:
© Doris van der Smissen, Judith A C Rietjens, Sandra van Dulmen, Ton Drenthen, F Ragnhild M D Vrijaldenhoven-Haitsma, Marijke Wulp, Agnes van der Heide, Ida J Korfage. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 02.12.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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  • Web-based Support of Advance Care Planning

    van der Smissen, D., 24 Apr 2024, Rotterdam. 265 p.

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