Hope and advance care planning in advanced cancer: Is there a relationship?

Abstract

Background Clinicians often cite a fear of giving up hope as a reason they defer advance care planning (ACP) among patients with advanced cancer. The objective of this study was to determine whether engagement in ACP affects hope in these patients. Methods This was a secondary analysis of a randomized controlled trial of primary palliative care in advanced cancer. Patients who had not completed ACP at baseline were included in the analysis. ACP was assessed in the forms of an end‐of‐life (EOL) conversation with one's oncologist and completion of a living will or advance directive (AD). Measurements were obtained at baseline and at 3 months. Hope was measured using the Herth Hope Index (HHI) (range, 12‐48; higher scores indicate higher hope). Multivariate regression was performed to assess associations between ACP and hope, controlling for baseline HHI score, study randomization, patient age, religious importance, education, marital status, socioeconomic status, time since cancer diagnosis, pain/symptom burden (Edmonton Symptom Assessment System), and anxiety/depression score (Hospital Anxiety and Depression Scale)—all variables known to be associated with ACP and/or hope. Results In total, 672 patients with advanced cancer were enrolled in the overall study. The mean age was 69 ± 10 years, and the most common cancer types were lung cancer (36%), gastrointestinal cancer (20%) and breast/gynecologic cancers (16%). In this group, 378 patients (56%) had not had an EOL conversation at baseline, of whom 111 of 378 (29%) reported having an EOL conversation by 3 months. Hope was not different between patients who did or did not have an EOL conversation over the study period (mean ± standard deviation ∆HHI, 0.20 ± 5.32 vs −0.53 ± 3.80, respectively; P = .136). After multivariable adjustment, hope was significantly increased in patients who had engaged in an EOL conversation (adjusted mean difference in ∆HHI, 0.95; 95% CI, 0.08‐1.82; P = .032). Similarly, of 216 patients (32%) without an AD at baseline, 67 (31%) had subsequently completed an AD. Unadjusted hope was not different between those who did and did not complete an AD (∆HHI, 0.20 ± 3.89 vs −0.91 ± 4.50, respectively; P = .085). After adjustment, hope was significantly higher in those who completed an AD (adjusted mean difference in ∆HHI, 1.31; 95% CI, 0.13‐2.49; P = .030). Conclusions The current results demonstrate that hope is not decreased after engagement in ACP and indeed may be increased. These findings may provide reassurance to clinicians who are apprehensive about having these important and difficult conversations. Lay Summary Many oncologists defer advance care planning (ACP) out of concern for giving up hope. This study demonstrates that hope is not decreased in patients who have engaged in ACP either as a conversation with their oncologists or by completing an advance directive. With this information, providers may feel more comfortable having these important conversations with their patients.

Awareness of Disease Status Among Patients With Cancer

“…A fully integrated model of primary palliative care in cancer settings improves HCP communication that meets patients and families "where they are" in the disease process and may promote accurate ADS. [78][79][80] Research implications include but are not limited to the need for (1) more in-depth understanding of the concept and influence of ADS as a predictor of decision-making and other clinical outcomes in the cancer setting, such as intensive care unit and palliative care utilization; (2) more robust investigations of interprofessional HCPs' and patients' perceptions of ADS across noncancer illnesses to better identify its role in clinical care delivery; and (3) evaluation of the resulting conceptual model (Figure 2) as applied to various stages of the cancer continuum for ADS instrument development. Future research should also elicit how ADS impacts decisional conflict and decisional self-efficacy, particularly during disease transitions or major decision inflection points that carry potentially substantial, irreversible, or long-term consequences.…”

“…In addition, several experts have recommended that training in primary palliative care (eg, generalist-level palliative care delivered by primary teams) for all HCPs would enhance individualized and holistic care that meets the psychosocial, physical, spiritual, and cultural contexts of patients. A fully integrated model of primary palliative care in cancer settings improves HCP communication that meets patients and families “where they are” in the disease process and may promote accurate ADS 78–80 …”

Body Image, Relationships, And Hope Among Cancer Patients

“…Apart from body image and interpersonal relationships, hope is crucial to battle against breast cancer and maintain a positive attitude in patients undergoing treatment. In a study by Cohen et al, (2022) a better quality of life, less pain and anxiety were seen in patients who had high level of hope that increased resilience, and enhanced coping skills. Also, if the levels of hope and self-compassion are high then lower psychological distress is observed in women suffering from breast cancer.…”

Advance care planning

“…Jednym z największych problemów pracowników ochrony zdrowia była obawa przed odebraniem nadziei na wyleczenie osobom i ich rodzinom poprzez angażowanie się w dyskusje dotyczące planowania opieki u kresu życia. Wyniki badań przeprowadzonych w 2022 r. sugerują jednak, że nadzieja po zaangażowaniu w rozmowy o planowaniu opieki może wzrosnąć [14].…”