Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

A randomized controlled trial of an advance care planning intervention for patients with incurable cancer (#75)

Stephanie B Johnson 1 , Phyllis Butow 1 , Melanie L Bell 2 , Karen Detering 3 , Josephine Clayton 4 , William Silvester 5 , Belinda E Kiely 6 , Stephen Clarke 7 , Lisa Vaccaro 1 , Martin R Stockler 6 , Philip Beale 8 , Natalie Fitzgerald 3 , Martin Tattersall 1
  1. Univeristy of Sydney, Camperdown, NSW, Australia
  2. Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson,, Arizona, USA
  3. Austin Health, Heidelberg, Victoria
  4. HammondCare Palliative and Supportive Care Service, Greenwich Hospital , Sydney, New South Wales, Australia
  5. University of Melbourne, Melbourne, Victoria, Australia
  6. National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
  7. Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
  8. Cancer Services , Sydney Local Health District (SLHD), Sydney, New South Wales, Australia


To determine whether an ACP intervention enables patients with cancer to receive care at the End of Life (EoL) consistent with their preferences.


Patients with incurable cancer, and a Family Member (FM), were randomised one-to-one to usual care or usual care plus an ACP intervention, between April 2014 and January 2017. Oncologists and participants were non-blinded. Participants were recruited from seven Australian metropolitan oncology centres. ACP was based on the Respecting Patient Choices model, with an offer of individualised typical, best-case and worst-case scenarios for expected survival time. 79 patients and 53 FMs attended an ACP discussion. The primary outcome measure, assessed by interview 3 months after patient death, was FM perception that the patient’s wishes were discussed, and met.


665 patients were referred by oncologists, 444 (66.8%) met the study inclusion criteria and were approached by a study researcher. 208 patients (46.8%) and their FM entered the trial as dyads. 53 (46%) dyads in the ACP group and 63 (54%) dyads in the usual care group had complete primary outcome data (p=0.16). FMs from 23 (43%) ACP and 21 (33%) usual care dyads reported the patient’s EoL wishes were discussed and met (difference = 10%, 95% CI:-2, 8, p = 0.27). There were no differences in EoL care received, patient satisfaction with care; FM satisfaction with care or with death; or FM well-being. Rates of palliative care referral were high in both groups (97% versus 96%).

Conclusions and Relevance: 

A formal ACP intervention provided no added benefit in cancer care where a cultural shift towards non-aggressive interventions at the EoL and routine palliative care referral has already occurred.

Trial Registration:

Australia and New Zealand Clinical Trials Registry ACTRN1261300128871.