B134
Advance care planning in advanced cancer: can it be achieved? A randomised controlled preference trial of a care planning discussion
Jane Harrington1, Cate Barlow1, Karon Ornadel2, Robyn Drake1, Michael King1, Louise Jones1
1University College London, UK, 2Marie Curie Hospice, London, UK
Background
Patients with recurrent cancer may have concerns about future needs and care. Enabling a discussion of advance care planning (ACP), as suggested by recent DH policy, might facilitate an increase in openness between patients, families and professionals.
Method
The aim of this study was to determine the acceptability and feasibility of an intervention consisting of a discussion with a trained mediator to facilitate planning for end-of-life care. Patients with advanced cancer attending oncology outpatient clinics were invited to participate. Measures at baseline and 8 week follow-up included preference for ACP intervention, HADS, visual analogue scales to assess communication with family, friends and clinicians, and possible completion of a written advance directive. The preference arms of the trial remained open until one of the arms reached 20, following this all patients were randomised. ACP discussions were structured to cover previous experiences of care, current problems and concerns, fears for the future, the role of close persons, and options for a written advance directive. Interviews were audio-taped and analysed for thematic content.
Results
Seventy-eight patients were recruited and 68 (88%) completed the trial, preference ACP n=21, preference usual care n=14, randomised ACP n=22, randomised usual care n=20. Forty patients completed one or more ACP discussions. There were no statistically significant differences in patient happiness with communication, overall discussion about preferred care or satisfaction with communication with health care professionals or family and friends. There were no significant differences in anxiety and depression between the groups. Qualitative analysis showed a variety of views: one third receiving the intervention found it very useful, others said it provided new information, a minority reported the discussion made them feel emotional.
Conclusion
This study provides evidence to inform the acceptability of introducing ACP discussions in end of life care and did not result in psychological distress.
