Supportive Care in Cancer

, Volume 21, Issue 8, pp 2195–2205 | Cite as

Understanding how cancer patients actualise, relinquish, and reject advance care planning: implications for practice

  • Natasha Michael
  • Clare O’Callaghan
  • Josephine Clayton
  • Annabel Pollard
  • Nikola Stepanov
  • Odette Spruyt
  • Michael Michael
  • David Ball
Original Article



Although advance care planning (ACP) is recognised as integral to quality cancer care, it remains poorly integrated in many settings. Given cancer patients’ unpredictable disease trajectories and equivocal treatment options, a disease-specific ACP model may be necessary. This study examines how Australian cancer patients consider ACP. Responses will inform the development of an Australian Cancer Centre’s ACP programme.


A constructivist research approach with grounded theory design was applied. Eighteen adults from lung and gastro-intestinal tumour streams participated. Participants first described their initial understanding of ACP, received ACP information, and finally completed a semi-structured interview assisted by the vignette technique. Qualitative inter-rater reliability was integrated.


Participants initially had scant knowledge of ACP. On obtaining further information, their responses indicated that: For cancer patients, ACP is an individualised, dynamic, and shared process characterised by myriad variations in choices to actualise, relinquish, and/or reject its individual components (medical enduring power of attorney, statement of choices, refusal of treatment certificate, and advanced directive). Actualisation of each component involves considering, possibly conversing about, planning, and communicating a decision, usually iteratively. Reactions can change over time and are informed by values, memories, personalities, health perceptions, appreciation of prognoses, and trust or doubts in their substitute decision makers.


Findings endorse the value of routinely, though sensitively, discussing ACP with cancer patients at various time points across their disease trajectory. Nonetheless, ACP may also be relinquished or rejected and ongoing offers for ACP in some patients may be offensive to their value system.


Advance care planning Cancer Adults Advance directives 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Natasha Michael
    • 1
  • Clare O’Callaghan
    • 2
    • 3
    • 4
  • Josephine Clayton
    • 5
    • 6
  • Annabel Pollard
    • 7
  • Nikola Stepanov
    • 8
  • Odette Spruyt
    • 2
  • Michael Michael
    • 9
  • David Ball
    • 10
  1. 1.Department of Pain and Palliative Care, Peter MacCallum Cancer CentreVictoriaAustralia
  2. 2.Department of Pain and Palliative Care, Peter MacCallum Cancer CentreMelbourneAustralia
  3. 3.Department of OncologyThe University of MelbourneMelbourneAustralia
  4. 4.Department of MedicineThe University of MelbourneMelbourneAustralia
  5. 5.HammondCare Palliative and Supportive Care ServiceSydneyAustralia
  6. 6.University of SydneySydneyAustralia
  7. 7.Department of PsychologyPeter MacCallum Cancer CentreMelbourneAustralia
  8. 8.School of Population Health and Melbourne Medical SchoolThe University of MelbourneMelbourneAustralia
  9. 9.Department of Cancer Medicine, Peter MacCallum Cancer CentreMelbourneAustralia
  10. 10.Department of Radiation Oncology, Peter MacCallum Cancer CentreMelbourneAustralia

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