Effects of Nurse-Led Promoting Advance Care Planning (NLP-ACP) on intention to engage in advance care planning and death anxiety among patients with chronic obstructive pulmonary disease in Thailand: A randomized controlled trial.

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) commonly experience distressing symptoms and death anxiety. In advanced stages, many receive aggressive treatments that may not align with their preferences. Advance care planning (ACP) may facilitate goal-concordant care and reduce death anxiety.

OBJECTIVE

To evaluate the effects of a Nurse-Led Promoting Advance Care Planning (NLP-ACP) program on intention to engage in ACP and death anxiety among patients with COPD.

METHODS

A single-blind randomized controlled trial was conducted among 60 patients with COPD, randomly assigned to an experimental or control group (30 each). The experimental group received a 2-week NLP-ACP intervention plus standard care, whereas the control group received standard care alone. Outcomes were assessed at baseline, post-intervention (week 2), and at follow-up (week 4). Intention to engage in ACP was measured using the Intentions for Advance Care Planning Questionnaire and analyzed using the Mann-Whitney U test and generalized estimating equations. Death anxiety was measured using the Death Anxiety Questionnaire and analyzed using a linear mixed model.

RESULTS

Compared with the control group, the experimental group showed significantly greater increases in intention to engage in ACP immediately after the intervention and at follow-up (Z = -5.584, p < 0.001, r = 0.72; Z = -6.047, p < 0.001, r = 0.78, respectively). In addition, significant group-by-time differences in ACP intention scores were observed between the experimental and control groups (Wald χ2 = 201.38, p < 0.001). The experimental group also showed significantly greater reductions in death anxiety, with significant group-by-time interactions immediately postintervention (β = 3.47, SE = 0.52, 95% CI [2.43, 4.50], p < 0.001, d = 0.70) and at follow-up (β = 6.70, SE = 0.93, 95% CI [4.84, 8.56], p < 0.001, d = 2.00).

CONCLUSIONS

The NLP-ACP program shows promise in increasing intention to engage in ACP and reducing death anxiety among patients with COPD, supporting patient-centered decision-making. However, findings should be interpreted cautiously because of the short follow-up period and single-blind design.

TRIAL REGISTRY NUMBER: Thai Clinical Trials Registry (TCTR20250416003).