Effects of a Program Promoting Advance Care Planning and Reducing Death Anxiety Among Thai Hemodialysis Patients: A Randomized Controlled Trial

Background: Patients on hemodialysis face severe physical and psychological strain, including death anxiety. Guided by the Theory of Planned Behavior, we assessed a program to increase patients’ intention to engage in advance care planning (ACP) and reduce death anxiety. Methods: In a single-blind randomized controlled trial at a tertiary-care hospital in Thailand, patients were randomly assigned to either the intervention or control group (n = 33, each group). The intervention comprised a 2-week ACP promotion program including an educational video, a discussion card game, and individualized counseling. Outcomes were assessed at baseline, immediately after the intervention (Week 2), and at 2-week follow-up (Week 4). Data were analyzed using two-way repeated-measures ANOVA, Friedman test, Wilcoxon signed-rank tests, and Mann–Whitney U test. Results: ACP intention showed significant effects for time (F(1.636, 104.715) = 10.030, p < 0.001) and time-by-group interaction (F(1.636, 104.715) = 3.700, p = 0.036), but no overall between-group effect (F(1, 64) = 2.158, p = 0.147). Death anxiety changed significantly over time in both the intervention group (χ²(2) = 18.950, p < 0.001) and the control group (χ²(2) = 7.462, p = 0.024). No significant between-group differences in death anxiety were observed. Conclusions: The program improved patients' intentions to engage in ACP over time. However, no significant between-group differences were detected. Therefore, the observed reduction could not be conclusively attributed to the intervention. Future studies with longer follow-up and behavioral measures of ACP engagement are needed to determine whether increased intention translates into sustained ACP participation and psychological benefits.