Factors influencing the engagement of cancer patients with advance care planning: A scoping review

INTRODUCTION: Advance care planning (ACP) is increasingly regarded as the best way to optimise end-of-life (EOL) care. Studies have examined a multitude of factors impacting on the lagging uptake of ACP. In the current study, we specifically focused on patient factors related to the uptake of ACP in adult cancer patients. METHODS: A scoping review was conducted, for which we searched the CINAHL, Cochrane, MEDLINE and PsycINFO databases (January 2013-December 2018). Studies exploring patient-related factors influencing the uptake of ACP in cancer patients were eligible for inclusion. RESULTS: Eleven papers and two overarching themes: person-related (e.g. socio-demographic) factors and "comprehension and awareness," were identified. White, well-educated patients with a support network were more likely to be involved in ACP. However, there is limited comprehension and awareness among cancer patients regarding ACP. CONCLUSIONS: The identified themes warrant a tailored approach to ACP. With regard to person-related factors, the existing body of knowledge on health literacy, disparities and shared decision-making should be used when designing strategies to improve ACP uptake. Further, our findings regarding "comprehension and awareness" suggest that ACP should not be limited to a narrow process without acknowledging the complexity surrounding personalised cancer care near the EOL.