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

Michael, Natasha, O'Callaghan, Clare, Clayton, Josephine, Pollard, Annabel, Stepanov, Nikola, Spruyt, Odette, Michael, Michael and Ball, David (2013) Understanding how cancer patients actualise, relinquish, and reject advance care planning: implications for practice. Supportive Care in Cancer, 21 8: 2195-2205. doi:10.1007/s00520-013-1779-6

Author Michael, Natasha
O'Callaghan, Clare
Clayton, Josephine
Pollard, Annabel
Stepanov, Nikola
Spruyt, Odette
Michael, Michael
Ball, David
Title Understanding how cancer patients actualise, relinquish, and reject advance care planning: implications for practice
Journal name Supportive Care in Cancer   Check publisher's open access policy
ISSN 0941-4355
Publication date 2013-08-01
Sub-type Article (original research)
DOI 10.1007/s00520-013-1779-6
Open Access Status
Volume 21
Issue 8
Start page 2195
End page 2205
Total pages 11
Place of publication Heidelberg, Germany
Publisher Springer
Language eng
Formatted abstract
Purpose: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Keyword Adults
Advance care planning
Advance directives
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 17 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 19 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Fri, 13 Jun 2014, 23:49:21 EST by Nikola Stepanov on behalf of School of Medicine