Factors influencing the engagement of cancer patients with advance care planning: A scoping review

Abstract

Introduction Advance care planning (ACP) is increasingly regarded as the best way to optimise end‐of‐life (EOL) care. Studies have examined a multitude of factors impacting on the lagging uptake of ACP. In the current study, we specifically focused on patient factors related to the uptake of ACP in adult cancer patients. Methods A scoping review was conducted, for which we searched the CINAHL, Cochrane, MEDLINE and PsycINFO databases (January 2013–December 2018). Studies exploring patient‐related factors influencing the uptake of ACP in cancer patients were eligible for inclusion. Results Eleven papers and two overarching themes: person‐related (e.g. socio‐demographic) factors and “comprehension and awareness,” were identified. White, well‐educated patients with a support network were more likely to be involved in ACP. However, there is limited comprehension and awareness among cancer patients regarding ACP. Conclusions The identified themes warrant a tailored approach to ACP. With regard to person‐related factors, the existing body of knowledge on health literacy, disparities and shared decision‐making should be used when designing strategies to improve ACP uptake. Further, our findings regarding “comprehension and awareness” suggest that ACP should not be limited to a narrow process without acknowledging the complexity surrounding personalised cancer care near the EOL.

Patient Experience Drivers of Overall Satisfaction With Care in Cancer Patients: Evidence From Responders to the English Cancer Patient Experience Survey

“…Alternatively, it might be that effective-care planning is put in place without the use of an explicit care plan document. A recent review of the literature indicates that both these mechanisms (which the authors term either lack of “comprehension” or “lack of awareness”) are often present in cancer patients ( 20 ).…”

Perceptions of involvement in advance care planning and emotional functioning in patients with advanced cancer

“…In addition, patients’ involvement in ACP may be overestimated due to the underrepresentation of patients with a migrant background. These patients are less likely to be involved in ACP than patients without a migrant background [ 9 ]. Moreover, the ACP statements used were self-developed and not validated [ 6 ].…”

Advance directives and real-world end-of-life clinical practice: a case–control study

“…7 Younger age, a lower level of education and a lower income have previously been shown to be associated with a reduced likelihood of advance care planning uptake. 24 The results also showed that the use of procedures at end of life is lower in women than in men, with both having completed an AD. This may indicate different preferences regarding end-of-life treatments, a higher respect for women's ADs-intensified by the fact that women tend to die once widowed, so there is no partner that could insist on a course of action-or some gender bias introduced by healthcare professionals.…”