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Advance care planning discussions in advanced cancer: Analysis of dialogues between patients and care planning mediators

  • Kelly A. Barnes (a1), Cate A. Barlow (a1), Jane Harrington (a1), Karon Ornadel (a1), Adrian Tookman (a1), Michael King (a2) and Louise Jones (a1)...
Abstract
AbstractObjective:

Advance care planning (ACP) provides patients with an opportunity to consider, discuss, and plan their future care with health professionals. Numerous policy documents recommend that ACP should be available to all with life-limiting illness.

Method:

Forty patients with recurrent progressive cancer completed one or more ACP discussions with a trained planning mediator using a standardized topic guide. Fifty-two interviews were transcribed verbatim and analyzed for qualitative thematic content.

Results:

Most patients had not spoken extensively to health professionals or close persons about the future. Their concerns related to experiencing distressing symptoms or worrying how family members would cope. Some patients wished for more accurate information and were unaware of their options for care. Many felt it was doctors' responsibility to initiate such discussions, but perceived that their doctors were reluctant to do so. However, some patients felt that the time was not yet right for these conversations.

Significance of results:

This article reports on the recorded content of ACP discussions. The extent to which patients want to engage in ACP is variable, and support and training are needed for health professionals to initiate such discussions. Our findings do not fully support the current United Kingdom policy of introducing ACP early in life-threatening disease.

Copyright
Corresponding author
Address correspondence and reprint requests to: Louise Jones, Department of Mental Health Sciences, 2nd Floor, UCL Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, United Kingdom. E-mail: l.jones@medsch.ucl.ac.uk
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K. Barnes , L. Jones , A. Tookman , (2007). Acceptability of an advance care planning interview schedule: A focus group study. Palliative Medicine, 21, 2328.

G. Bravo , M.F. Dubois & B. Wagneur (2008). Assessing the effectiveness of interventions to promote advance directives among older adults: A systematic review and multi-level analysis. Social Science and Medicine, 67, 11221132.

J.R. Curtis , D.L. Patrick , E.S. Caldwell , (2000). Why don't patients and physicians talk about end-of-life care? Barriers to communication for patients with acquired immunodeficiency syndrome and their primary care clinicians. Archives of Internal Medicine, 160, 16901696.

S.N. Davison & C. Simpson (2006). Hope and advance care planning in patients with end stage renal disease: Qualitative interview study. British Medical Journal, 333, 886.

M. Gott , C. Gardiner , N. Small , (2009). Barriers to advance care planning in chronic obstructive pulmonary disease. Palliative Medicine, 23, 642648.

G. Horne , J. Seymour & K. Shepherd (2006). Advance care planning for patients with inoperable lung cancer. International Journal of Palliative Nursing, 12, 172178.

M. Jezewski , M. Meeker & M. Schrader (2003). Voices of oncology nurses: What is needed to assist patients with advanced directives. Cancer Nursing, 26, 105112.

S.C. Johnston , M.P. Pfeifer & R. McNutt (1995). The discussion about advance directives. Patient and physician opinions regarding when and how it should be conducted. Archives of Internal Medicine, 155, 10251030.

R.S. Morrison , E. Chichin , J. Carter , (2005). The effect of a social work intervention to enhance advance care planning documentation in the nursing home. Journal of the American Geriatric Society, 53, 290294.

R.S. Morrison & D.E. Meier (2004). High rates of advance care planning in New York City's elderly population. Archives of Internal Medicine, 164, 24212426.

D. Munday , M. Petrova & J. Dale (2009). Exploring preferences for place of death with terminally ill patients: qualitative study of experiences of general practitioners and community nurses in England. British Medical Journal, 339, 214218.

R.A. Pearlman , H. Starks , K.C. Cain , (2005). Improvements in advance care planning in the Veterans Affairs System: results of a multifaceted intervention. Archives of Internal Medicine, 165, 667674.

E.E. Prommer (2010). Using the values-based history to fine-tune advance care planning for oncology patients. Journal of Cancer Education, 25, 6669.

E. Ratner , L. Norlander & K. McSteen (2001). Death at home following a targeted advance care planning process at home: The kitchen table discussion. Journal of the American Geriatric Society, 49, 778781.

K.E. Rosenfeld , N.S. Wenger & M. Kagawa-Singer (2000). End of life decision making: A qualitative study of elderly individuals. Journal of General Internal Medicine, 15, 620625.

A.D. Schickedanz , D. Schillinger , C.S. Landefeld , (2009). A clinical framework for improving the advance care planning process: Start with patients' self-identified barriers. Journal of the American Geriatric Society, 57, 3139.

C. Schwartz , I. Lennes , B. Hammes , (2003) Honing an advance care planning intervention using qualitative analysis: The Living Well interview. Journal of Palliative Medicine, 6, 593603.

P.A. Singer , D.K. Martin , J.V. Lavery , (1998). Reconceptualizing advance care planning from the patient's perspective. Archives of Internal Medicine, 158, 879884.

P.A. Singer , D.K. Martin & K. Merrijoy (1999). Quality end of life care: patients' perspectives. Journal of the American Medical Association, 281, 163168.

R. Voltz , A. Akabayashi , C. Reese , (1998). End of life decisions and advance directives in palliative care: A cross cultural survey of patients and health-care professionals. Journal of Pain Symptom Management, 16, 153162.

A. Walling , K.A. Lorenz , S.M. Dy , (2008). Evidence-based recommendations for information and care planning in cancer care. Journal of Clinical Oncology, 26, 38963902.

N.R. Zweibel & C.K. Cassel (1989). Treatment choices at the end of life: A comparison of decisions by older patients and their physician-selected proxies. Gerontologist, 29, 615621.

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Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
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