Advance care planning in patients with brain tumours: A prospective cohort study

Song, Krystal; Amatya, Bhasker; Khan, Fary

doi:10.14312/2052-4994.2015-12

Cited by 7 publications

(9 citation statements)

References 22 publications

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“…This prospective study explored insights from BT patients regarding their experience with ACP, perspectives on the timing of conducting discussions and identified factors that influence future health care decisions and EOL issues. The findings from this study further builds on a previous pilot feasibility study [19]. Firstly, this study highlighted the ongoing limited awareness and discussions in relation to ACP with BT patients who often experience complex neuro-palliative needs.…”

Section: Discussionsupporting

confidence: 64%

“…Although the body of research in this area is growing, a recent systematic review highlighted sparse literature and lack of high quality studies examining ACP in BT patients, with heterogeneity amongst studies and their findings [20]. Our previous pilot feasibility study in a tertiary hospital in Australia had demonstrated limited awareness and experience of ACP in BT patients, highlighting gaps in the provision of ACP discussions in a tertiary centre [19]. This study extends on the findings of the previous pilot study.…”

Section: Introductionmentioning

confidence: 51%

“…Clear communication and collaboration with primary healthcare service providers regarding patients' treatment and care plans will enhance the frequency and quality of ACP conversations with patients. The use of trained non-medical ACP mediators including nursing and allied health, working in conjunction with medical specialists who have been found to be the preferred facilitator, will also be able to offer more available sessions in providing ACP information, and establishing clear and realistic expectations of goals of care verbally [19]. This is in line with other organization initiatives in Australia such as Respecting Patient Choices program [6,34].…”

Section: Discussionmentioning

confidence: 74%

“…ACP has been widely explored in the literature in different patient cohorts, including cancer, chronic renal failure, heart failure, chronic obstructive pulmonary disease and other life-limiting conditions. Several studies had previously investigated ACP in BT cohort [17,18,19]. Although the body of research in this area is growing, a recent systematic review highlighted sparse literature and lack of high quality studies examining ACP in BT patients, with heterogeneity amongst studies and their findings [20].…”

Section: Introductionmentioning

confidence: 99%

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Advance Care Planning in brain tumour survivors: a prospective study

2017

IJCRT

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Purpose: Advance care planning (ACP) is the process of planning for future healthcare to guide clinical decision making when one is unable to communicate decisions due to lack of capacity. This study explored the perspectives of brain tumour (BT) patients in discussing ACP, symptom profile, physical and functional status, quality of life (QoL), level of coping and carer burden. Methods: A prospective cohort study with semi-structured interviews regarding ACP for BT patients in hospital and community. Validated assessment tools measured coping strategies, QoL and carer burden. Interview ACP transcripts were analyzed, coded and interpreted using qualitative analytic techniques for thematic analyses. Results: Participants’ (n=36) mean age was 47 years (range 20-69 years), with median time since diagnosis of 3.9 years and majority (70%) had glioblastoma multiforme (GBM). Fatigue was the most common symptom reported by 89% participants, followed by pain (53%) and cognitive impairment (39%). Overall, participants indicated good QoL and used more problem-focused coping strategies including ‘acceptance’ and ‘positive reframing’. There was a ‘moderate’ level of carer burden. Thematic analyses indicated participants had limited understanding of ACP, and lack of such discussions with healthcare professionals. Majority preferred dedicated sessions by trained healthcare professionals especially medical staff. Conclusion: The low uptake of ACP amongst BT patients’ highlights need for increased awareness of ACP in clinical practice as it has an important role in enhancing patient autonomy and delivery of quality end-of-life care. The neuropalliative-rehabilitation model of care integrates care with treating teams and can provide timely ACP information to BT patients, with the need for multifaceted system-wide interventions in implementing ACP

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

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Advance Care Planning in brain tumour survivors: a prospective study

2017

IJCRT

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“…In a study examining EOL care in HGG patients conducted in three European countries, the authors reported significant contrast in written AD completion, including 46% in Dutch, 37% in British, and only 6% in Austrian patients ( p < 0.001) ( 28 ). Overall, the findings from the included studies in this review showed that around 0–76% of pmBT patients had an AD completed ( 3 , 5 , 17 , 18 , 23 , 26 , 28 , 30 , 31 , 34 ). The nomination of health care proxies ranged from 8 to 77% among the studies ( 3 , 22 , 26 ).…”

Section: Resultsmentioning

confidence: 84%

Advance Care Planning in Patients with Primary Malignant Brain Tumors: A Systematic Review

et al. 2016

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Advance care planning (ACP) is a process of reflection and communication of a person’s future health care preferences, and has been shown to improve end-of-life (EOL) care for patients. The aim of this systematic review is to present an evidence-based overview of ACP in patients with primary malignant brain tumors (pmBT). A comprehensive literature search was conducted using medical and health science electronic databases (PubMed, Cochrane, Embase, MEDLINE, ProQuest, Social Care Online, Scopus, and Web of Science) up to July 2016. Manual search of bibliographies of articles and gray literature search were also conducted. Two independent reviewers selected studies, extracted data, and assessed the methodologic quality of the studies using the Critical Appraisal Skills Program’s appraisal tools. All studies were included irrespective of the study design. A meta-analysis was not possible due to heterogeneity amongst included studies; therefore, a narrative analysis was performed for best evidence synthesis. Overall, 19 studies were included [1 randomized controlled trial (RCT), 17 cohort studies, 1 qualitative study] with 4686 participants. All studies scored “low to moderate” on the methodological quality assessment, implying high risk of bias. A single RCT evaluating a video decision support tool in facilitating ACP in pmBT patients showed a beneficial effect in promoting comfort care and gaining confidence in decision-making. However, the effect of the intervention on quality of life and care at the EOL were unclear. There was a low rate of use of ACP discussions at the EOL. Advance directive completion rates and place of death varied between different studies. Positive effects of ACP included lower hospital readmission rates, and intensive care unit utilization. None of the studies assessed mortality outcomes associated with ACP. In conclusion, this review found some beneficial effects of ACP in pmBT. The literature still remains limited in this area, with lack of intervention studies, making it difficult to identify superiority of ACP interventions in pmBT. More robust studies, with appropriate study design, outcome measures, and defined interventions are required to inform policy and practice.

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Palliative and end‐of‐life care

Hensby,

Sheridan

2021

Clinical Cases in Paramedicine

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Advance care planning in patients with brain tumours: A prospective cohort study

Cited by 7 publications

References 22 publications

Advance Care Planning in brain tumour survivors: a prospective study

Advance Care Planning in brain tumour survivors: a prospective study

Advance Care Planning in Patients with Primary Malignant Brain Tumors: A Systematic Review

Palliative and end‐of‐life care

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