Objectives The objective of this study is to develop a care pathway for a hospital‐based advance care planning service for cancer patients. Methods A web‐based modified Delphi study consulted an expert panel consisting of a convenience sample of stakeholders including professionals with a special interest in advance care planning as well as a ‘public and patient involvement group’. After generating ideas for core elements of a care pathway in the first round, numerical ratings and rankings informed the multi‐professional research steering group's decision process eventually resulting in a final pathway. Results The 41 participants in the Delphi study identified 177 potential core elements of the pathway in the first round. In two further rounds, consensus was reached on a final version of the pathway with 148 elements covering the 10 domains: prerequisites, organisation and coordination, identification and referral, provision of information, information sources, family involvement, advance care planning discussion, documentation, update and quality assurance. Conclusion We propose a care pathway for advance care planning for hospital patients with cancer based on the results of a Delphi study that reached consensus on an implementation strategy. Our study pioneers the standardisation of the process and provides input for further policy and research with the aim of aligning cancer patients' care with their preferences and values.

Background: Engaging in end-of-life care considerations is beneficial when the time is right. The purpose of this study is to provide a valid instrument to assess peoples readiness for end-of-life conversations before they are initiated.Materials and Methods: A community sample was recruited in study one for exploratory factor analysis of a 13-item questionnaire. In study two, psychometric properties were analyzed with structural equation modeling in a population affected by cancer. Convergent and discriminant validity were assessed with questionnaires measuring distress, depression, anxiety, fear of progression, and distress of death and dying.Results: In study one (N = 349) exploratory factor analysis resulted in three subscales readiness (α = 0.84), communication (α = 0.76), and values (α = 0.56) with a possible common factor (α = 0.84) for a community sample. In study two (N = 84) the three-factor solution with 13 items was not supported for cancer patients. Factor structure was adapted to 12 items with one common factor readiness (α = 0.87). Model fit was good: χ2(50) = 59.18, p>0.05 (Satorra-Bentler-correction = 1.27), with χ2/df = 1.184, rRMSEA = 0.053 (90%-CI[0.000;0.100]), and rSRMR = 0.072. Convergent validity was supported by moderate correlations to trait gratitude, ratings of readiness to provide a living will or talk with family about the end of life. Divergent validity was supported by no or small correlation with distress, depression, general and death anxiety and fear of progression, respectively.Conclusions: Results support usage of the REOLC Scale in different settings with adapted factor structure. The questionnaire is interpreted as valid and reliable instrument to assess objective readiness for end-of-life conversations.

Objective Fear of cancer recurrence or progress is strongly related to death anxiety (DA) in cancer patients, but due to lack of conceptualization and measurement methods, the relationship was not analyzed quantitatively before. The aim of the present study was to investigate the conceptual relationship of both constructs, with DA expected to be the general construct. Methods Cancer patients (N = 121) participated in an online study. They provided information on socio‐demographical, medical and psychological measures including DA and fear of cancer recurrence or progression (FoP‐Q‐SF). Relation of constructs was assessed using a two‐step process: Confirming individual construct structure with confirmatory factor analysis, including correlation of constructs and modification of measurement model, followed by structural equation modeling and comparison of structure models for best model fit. Results The measurement model was modified to include three residual correlations within and between constructs. Comparison of structure models supported a bifactor structure with DA as general factor and fear of recurrence or progression as group factor: SBχ2 (173) = 207.74 (p < 0.05), SB = 1.538, relative χ2 = 1.2, rRMSEA = 0.05 [0.01, 0.07] (p > 0.05), SRMR = 0.07, CFI = 0.94, AIC = 7543.60. Conclusions DA can be interpreted as general factor to fear of cancer recurrence or progression. Psychological interventions to reduce emotional burden of cancer patients need to focus additionally on existential threat and individual fears regarding DA.

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