Advance Care Planning Communication: Oncology Patients and Providers Voice their Perspectives
- 302 Downloads
Advance care planning helps to ensure that patients’ end-of-life preferences are understood and discussed with providers. It is an important component of patient-centered care, particularly when patients are facing life-limiting illness. It also has ethical implications for providers, yet evidence suggests that these conversations are not always occurring, particularly in underserved populations. The aim of this study was to understand the challenges and personal beliefs regarding ACP through interviews with patients undergoing active cancer treatment and their oncology providers. This study took place at an urban, multispecialty cancer center in the mid-Atlantic region where approximately 1400 patients are treated each year. Findings revealed differences among both patients and providers in terms of their ACP knowledge, preferences, and practices. Overall, 70% of patients were familiar with advance directives (100% of White patients and 45.5% of Black patients), yet only 35% of them reported having completed one (55.6% of White patients and 18.2% of Black patients, although not statistically significant). Most providers (70%) held ACP conversations with patients with advanced illness only. They tended to make assumptions about the amount of information that patients desired and noted the significant challenges that were inherent with these types of conversations. Overall, ethical implications are inherent in ACP as patients are making medical decisions without always having necessary information. There are various reasons why providers may not supply information regarding potential outcomes and end-of-life planning and why patients may not request (or know to request) more medical information.
KeywordsOncology Advance care planning End of life
The authors would like to express their appreciation for those who supported our work, including Margaret Meyer, Khaled el-Shami, Krista Nelson, and Tara Schapmire. Special thanks also go out to the Zelda Foster Leadership Program in Palliative Care.
Compliance with Ethical Standards
There is no funding to report for this project.
- 3.Institute of Medicine (2015) Dying in America: improving quality and honoring individual preferences near the end of life. The National Academies Press, Washington, DCGoogle Scholar
- 4.American Medical Association: Code of Medical Ethics, 6/2016 update. https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-5.pdf
- 12.Smith AK, Mccarthy EP, Paulk E, Balboni TA, Maciejewski PK, Block SD, Prigerson HG (2008) Racial and ethnic differences in advance care planning among patients with cancer: impact of terminal illness acknowledgment, religiousness, and treatment preferences. J Clin Oncol 26:4131–4137CrossRefGoogle Scholar
- 13.Erickson SE, Vasilevskis EE, Kuzniewicz MW, Cason BA, Lane RK, Dean ML, Rennie DJ, Dudley AD (2013) The effect of race and ethnicity on outcomes among patients in the intensive care unit: a comprehensive study involving socioeconomic status and resuscitation preferences. Crit Care Med 39:429–435CrossRefGoogle Scholar