A summary of the Action Project
The ACTION project studied the effects of the facilitated, structured ACP program Respecting Choices which was adapted to a European context, on the quality of life of patients with advanced lung or colorectal cancer. In a phase III multicentre cluster randomised controlled trial, 23 hospitals in six countries were randomised: in the intervention sites, patients were offered interviews with a trained facilitator, whereas in the control sites, patients received care as usual. Participating patients completed questionnaires at inclusion, and again after 2.5 and 4.5 months. Use of medical care was assessed by checking medical files.
The study’s primary endpoint was patients’ emotional functioning (EORTC-QLQ-C30) at 2.5 months post-inclusion. Secondary endpoints were patients quality of life and symptoms, patients’ evaluation of decision-making processes, quality of end-of-life care and cost-effectiveness of the intervention. A complementary qualitative study was carried out to explore the lived experience of engagement with the ACTION Respecting Choices ACP program from the perspectives of patients, their Personal Representatives (a nominated family or friend) and the facilitators.
The total number of included patients was 1,117. In the intervention group, 396 patients participated in Respecting Choices ACP conversations (90%). The mean number of facilitated conversations per patient was 1.3 and the average time they took was 93 minutes. Facilitators on average delivered 86% of the key elements of the ACP conversation in the correct way.
The main outcomes of the trial, the cost-effectiveness of the intervention, and the qualitative study findings have been described in draft scientific publications that are currently under review or will be submitted to international journals in due course. Once they are published, they will be posted on this website. The ACTION project was completed in May 2019.
How did the ACTION Project work?
This project was funded by the European Union under the FP7 Health Programme, grant agreement ID: 602541 and was led by Professor Agnes van der Heide, Erasmus MC, Rotterdam, the Netherlands.
The primary objective of ACTION was to assess whether ACP improved the quality of life and symptoms of patients with advanced cancer.
The secondary objectives of ACTION were:
- To assess the effect of an ACP program on the quality of life and symptoms of patients with advanced cancer in different subgroups (gender, age, socioeconomic class, country);
- To assess the effect of ACP on the extent to which care as received was in line with patients’ preferences, on patients’ evaluation of the quality of the decision making process, on the quality of dying of patients with advanced cancer, and on the relatives’ wellbeing;
- To gain insight into how patients, their relatives and professional caregivers experienced their involvement in ACP;
- To assess the cost effectiveness of ACP.