Content analysis of Advance Directives completed by patients with advanced cancer as part of an Advance Care Planning intervention: insights gained from the ACTION trial
Zwakman, Marieke; van Delden, J J M; Jabbarian, L J; Johnsen, A T; Korfage, I J; Preston, N J; Kars, M C; ACTION consortium
(2020) Supportive Care in Cancer, volume 28, issue 3, pp. 1513 - 1522
(Article)
Abstract
PURPOSE: Writing an Advance Directive (AD) is often seen as a part of Advance Care Planning (ACP). ADs may include specific preferences regarding future care and treatment and information that provides a context for healthcare professionals and relatives in case they have to make decisions for the patient. The aim
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of this study was to get insight into the content of ADs as completed by patients with advanced cancer who participated in ACP conversations. METHODS: A mixed methods study involving content analysis and descriptive statistics was used to describe the content of completed My Preferences forms, an AD used in the intervention arm of the ACTION trial, testing the effectiveness of the ACTION Respecting Choices ACP intervention. RESULTS: In total, 33% of 442 patients who received the ACTION RC ACP intervention completed a My Preferences form. Document completion varied per country: 10.4% (United Kingdom), 20.6% (Denmark), 29.2% (Belgium), 41.7% (the Netherlands), 61.3% (Italy) and 63.9% (Slovenia). Content analysis showed that 'maintaining normal life' and 'experiencing meaningful relationships' were important for patients to live well. Fears and worries mainly concerned disease progression, pain or becoming dependent. Patients hoped for prolongation of life and to be looked after by healthcare professionals. Most patients preferred to be resuscitated and 44% of the patients expressed maximizing comfort as their goal of future care. Most patients preferred 'home' as final place of care. CONCLUSIONS: My Preferences forms provide some insights into patients' perspectives and preferences. However, understanding the reasoning behind preferences requires conversations with patients.
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Keywords: Advance Care Planning, Advance Directive, Cancer, Content analysis, End of life, Oncology, Journal Article
ISSN: 0941-4355
Publisher: Springer-Verlag
Note: Funding Information: This study is part of a larger study about advance care planning in oncology: the ACTION study. The ACTION study (Advance care planning—an innovative palliative care intervention to improve quality of life in oncology) is a collaboration between research teams in the Netherlands, Denmark, Belgium, Slovenia, the UK and Italy. The 7th Framework Programme for Research and Technological Development (FP7) from the European Commission is funding the study (Proposal No: 602541-2). Funding Information: This publication is based on the ACTION project (Advance care planning—an innovative palliative care intervention to improve quality of life in oncology), conducted by a collaboration of research teams from the Netherlands, Denmark, Belgium, Slovenia, the UK and Italy. The project is funded by the 7th Framework Programme for Research and Technological Development (FP7) (Proposal No: 602541-2). We thank all participating patients and relatives, facilitators, trainers, hospital staff and the Advisory Board for their valuable contribution to this project. We thank Bud Hammes and Linda Briggs for their advice throughout the project. Publisher Copyright: © 2019, The Author(s).
(Peer reviewed)