Aims:
Advance care planning is beneficial to both people affected by cancer and health services, and there are strategies across Australia to improve implementation. However it is assumed that patients are able to articulate their wishes, understand processes and communicate their plans. The aim of this study was to: explore how people with cancer understand their advance care plans, and compare their wishes with documentation.
Methods:
People with a diagnosis of cancer and an advance care plan recorded were eligible; specifically Refusal of Treatment Certificate, Enduring Power of Attorney (Medical Treatment) or Statement of Choices. This research used a qualitative descriptive design which included grounded theory techniques. Analysis was conducted with an inductive, cyclic and constant comparative procedure; summarising the data into codes, categories and themes. Interview data was compared with advance directives.
Results:
Fourteen participants were interviewed (12 females(86%); median age=73 years). Participants had a range of cancer diagnoses including gastrointestinal (n=4;29%) and haematological (n=4;29%).
Three themes were evident: i) Incomplete advance care planning comprehension and confidence; ii) Attitude and documentation can be fragmented; iii) Advance care planning is helpful but can be improved.
Many participants reported an incomplete understanding about their advance care plans. Some used tentative language when describing how various components of advance care plans could be used in practice. Many were uncertain about their advance care plans being actualised, and described limited confidence about professional awareness of the documentation. Most advance directives only partially reflected the advance care planning statements made by participants. Most participants felt creating an advance directive was helpful through enabling them to consider what they wanted.
Conclusions:
Ensuring people with cancer comprehend and engage with advance care planning is paramount, however patient comprehension is lacking and there can be a lack of concurrence between patient wishes and documentation.