OP25 A randomized trial of a ‘goals of care’ decision support intervention (planwell™) in primary care in alberta, canada

We aimed to determine the efficacy of a recently developed decision support intervention, PlanWell™, which was designed to improve the quality of Goals of Care Determinations (GCD) in primary care settings. We conducted a multicenter randomized trial of patients considered by the primary care doctor to require establishment or review of GCD. Enrolled patients were randomized to receive the study intervention by a trained facilitator or usual care. Outcomes included preferences for life-sustaining treatments, a modified decisional conflict score (DCS), and the proportion of patients who with completed GCD form 8–12 weeks post intervention. Physician ratings of DCS and amount of time spent with patient obtaining GCD were also compared. 123 were consented and randomized, 115 completed the trial. Of enrolled patients, 52% were male and the average age was 74 years. Post intervention, fewer intervention patients preferred CPR and ICU care (15% vs. 30%, p=0.25). Patients in the intervention group were better informed (p=0.03) and feeling more support from the physician (p=0.03). The completion rate of GCD forms was similar in both groups (96.7% intervention vs. 94.0% usual care, p=0.71). Physicians considered intervention patients to be better informed (p=0.07) and to have a clear sense of their values (p=0.04) and spent less time with them (9.7 vs 13.0 mins, p<0.001) compared to usual care patients. The PlanWell™ intervention seems to help clarify values, better inform patients and may reduce preference for resuscitation, while reducing the physician’s time to accomplish GCD decisions.