Advance care planning in advanced cancer: patient -professional dialogues

Advance care planning (ACP) is a process of discussion between patients and care providers to clarify an individual’s wishes in the context of an expected deterioration in health. It may lead to documentation of preferences for future healthcare or appointment of a person to make healthcare decisions were the patient to lose the mental capacity (Lasting Power of Attorney). Research into ACP is important in the light of government initiatives to improve end-of-life care. We present qualitative findings from the content of an ACP intervention used in a feasibility randomised controlled trial. Method Forty patients with recurrent progressive cancer completed one or more ACP discussions with a trained mediator using a standardised topic guide covering communication with health professionals and close persons, feelings about the future and the dying process, preferences for place of care and future healthcare decisions. Fifty-two discussions were audio-taped, transcribed verbatim, and analysed using thematic content analysis. Results Most patients had not spoken extensively to health professionals or close persons about the future. Some patients felt that the time was not yet right for these conversations. Concerns related to experiencing distressing symptoms or how family members would cope. Over one third of patients expressed fears about the dying process, some of which stemmed from distress watching others die. Some wished for more accurate information and were unaware of options for care. Many felt it was doctors’ responsibility to initiate such discussions, but perceived that doctors were reluctant to do so. Conclusion There is considerable variation in the extent to which patients want to engage in ACP discussions. Some patients were not ready, even in late disease. Support and training may help health professionals to initiate such discussions. Our findings do not fully support current UK policy of introducing ACP early in life threatening disease.