Advance Care Planning Communication: Oncology Patients and Providers Voice their Perspectives
- 29 April 2017
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Cancer Education
- Vol. 33 (5), 1140-1147
- https://doi.org/10.1007/s13187-017-1225-4
Abstract
Advance care planning helps to ensure that patients’ end-of-life preferences are understood and discussed with providers. It is an important component of patient-centered care, particularly when patients are facing life-limiting illness. It also has ethical implications for providers, yet evidence suggests that these conversations are not always occurring, particularly in underserved populations. The aim of this study was to understand the challenges and personal beliefs regarding ACP through interviews with patients undergoing active cancer treatment and their oncology providers. This study took place at an urban, multispecialty cancer center in the mid-Atlantic region where approximately 1400 patients are treated each year. Findings revealed differences among both patients and providers in terms of their ACP knowledge, preferences, and practices. Overall, 70% of patients were familiar with advance directives (100% of White patients and 45.5% of Black patients), yet only 35% of them reported having completed one (55.6% of White patients and 18.2% of Black patients, although not statistically significant). Most providers (70%) held ACP conversations with patients with advanced illness only. They tended to make assumptions about the amount of information that patients desired and noted the significant challenges that were inherent with these types of conversations. Overall, ethical implications are inherent in ACP as patients are making medical decisions without always having necessary information. There are various reasons why providers may not supply information regarding potential outcomes and end-of-life planning and why patients may not request (or know to request) more medical information.Keywords
This publication has 12 references indexed in Scilit:
- Discussions of Life Expectancy and Changes in Illness Understanding in Patients With Advanced CancerJournal of Clinical Oncology, 2016
- Patients' Expectations about Effects of Chemotherapy for Advanced CancerThe New England Journal of Medicine, 2012
- Current Practices in Advance Care PlanningClinical Journal of Oncology Nursing, 2011
- The effect of race and ethnicity on outcomes among patients in the intensive care unit: A comprehensive study involving socioeconomic status and resuscitation preferences*Critical Care Medicine, 2011
- American Society of Clinical Oncology Statement: Toward Individualized Care for Patients With Advanced CancerJournal of Clinical Oncology, 2011
- Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient ChoiceThe Journal of Law, Medicine & Ethics, 2010
- Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement AdjustmentJAMA, 2008
- Racial and Ethnic Differences in Advance Care Planning Among Patients With Cancer: Impact of Terminal Illness Acknowledgment, Religiousness, and Treatment PreferencesJournal of Clinical Oncology, 2008
- Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic reviewPalliative Medicine, 2007
- Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study Commentary: Why do doctors overestimate? Commentary: Prognoses should be based on proved indices not intuitionBMJ, 2000