TY - JOUR
T1 - Advance care planning in cancer
T2 - Patient preferences for personnel and timing
AU - Kubi, Boateng
AU - Istl, Alexandra C.
AU - Lee, Kimberley T.
AU - Conca-Cheng, Alison
AU - Johnston, Fabian M.
N1 - Funding Information:
Supported by the US Department of Health and Human Services, Agency for Healthcare Research and Quality Grant No. 1K08HS024736.
Publisher Copyright:
© 2020 by American Society of Clinical Oncology
PY - 2020/9/1
Y1 - 2020/9/1
N2 - PURPOSE Opportunities for advance care planning (ACP) discussions continue to be missed despite the demonstrated benefit of such conversations. This is in part because of a poor understanding of patient preferences. We aimed to determine oncology patients' preferences surrounding ACP with a focus on the choice of which health care providers to have the conversation with and the timing of conversations. METHODS A cross-sectional 19-question survey of surgical and medical oncology patients in a tertiary care hospital was conducted that assessed knowledge, experience, and preferences surrounding ACP. Quantitative variables were reported with descriptive statistics, and a coding structure was developed to analyze qualitative data. RESULTS Two hundred patients were surveyed. Only 24% of patients reported previously having ACP discussions with their physicians despite 82.5% reporting a wish to do so. Patients felt that these discussions were a priority for them (to alleviate familial guilt, maintain control, and prevent others' values from guiding end-of-life care), but they reported that previous experiences with ACP had been neither comprehensive nor effective. Most patients (43.5%) preferred to have ACP discussions with their primary care providers (PCPs) compared with 7% preferring their surgeon and 5.5% preferring their oncologist. Trust and familiarity with PCPs arose as the dominant theme underlying this selection. Most patients (94%) preferred to have ACP discussions early, with 45% wishing such a discussion had been initiated before their cancer diagnosis. CONCLUSION Patients with cancer prefer to have ACP discussions with their PCPs and prefer to do so early in their disease course.
AB - PURPOSE Opportunities for advance care planning (ACP) discussions continue to be missed despite the demonstrated benefit of such conversations. This is in part because of a poor understanding of patient preferences. We aimed to determine oncology patients' preferences surrounding ACP with a focus on the choice of which health care providers to have the conversation with and the timing of conversations. METHODS A cross-sectional 19-question survey of surgical and medical oncology patients in a tertiary care hospital was conducted that assessed knowledge, experience, and preferences surrounding ACP. Quantitative variables were reported with descriptive statistics, and a coding structure was developed to analyze qualitative data. RESULTS Two hundred patients were surveyed. Only 24% of patients reported previously having ACP discussions with their physicians despite 82.5% reporting a wish to do so. Patients felt that these discussions were a priority for them (to alleviate familial guilt, maintain control, and prevent others' values from guiding end-of-life care), but they reported that previous experiences with ACP had been neither comprehensive nor effective. Most patients (43.5%) preferred to have ACP discussions with their primary care providers (PCPs) compared with 7% preferring their surgeon and 5.5% preferring their oncologist. Trust and familiarity with PCPs arose as the dominant theme underlying this selection. Most patients (94%) preferred to have ACP discussions early, with 45% wishing such a discussion had been initiated before their cancer diagnosis. CONCLUSION Patients with cancer prefer to have ACP discussions with their PCPs and prefer to do so early in their disease course.
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U2 - 10.1200/JOP.19.00367
DO - 10.1200/JOP.19.00367
M3 - Article
C2 - 32282265
AN - SCOPUS:85090818580
SN - 2688-1527
VL - 16
SP - E875-E883
JO - JCO Oncology Practice
JF - JCO Oncology Practice
IS - 9
ER -