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

Abstract

Purpose Advance Care Planning (ACP) is positively associated with the quality of care, but its impact on emotional functioning is ambiguous. This study investigated the association between perceptions of ACP involvement and emotional functioning in patients with advanced cancer. Methods This study analyzed baseline data of 1,001 patients of the eQuiPe study, a prospective, longitudinal, multicenter, observational study on quality of care and quality of life in patients with advanced cancer in the Netherlands. Patients with metastatic solid cancer were asked to participate between November 2017 and January 2020. Patients’ perceptions of ACP involvement were measured by three self-administered statements. Emotional functioning was measured by the EORTC-QLQ-C30. A linear multivariable regression analysis was performed while taking gender, age, migrant background, education, marital status, and symptom burden into account. Results The majority of patients (87%) reported that they were as much involved as they wanted to be in decisions about their future medical treatment and care. Most patients felt that their relatives (81%) and physicians (75%) were familiar with their preferences for future medical treatment and care. A positive association was found between patients’ perceptions of ACP involvement and their emotional functioning (b=0.162, p<0.001, 95%CI[0.095;0.229]) while controlling for relevant confounders. Conclusions Perceptions of involvement in ACP are positively associated with emotional functioning in patients with advanced cancer. Future studies are needed to further investigate the effect of ACP on emotional functioning. Trial registration number NTR6584 Date of registration: 30 June 2017 Implications for Cancer Survivors Patients’ emotional functioning might improve from routine discussions regarding goals of future care. Therefore, integration of ACP into palliative might be promising.

Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium

“…In the Netherlands, dialogues between patients and their treating physicians regarding treatment restrictions are part of daily clinical practice [ [13] , [14] , [15] ], as illustrated by the number of treatment restrictions that had been discussed in the DOCC registry. Nevertheless, the incidence and characteristics of fatal cases within this registry were comparable to other registries [ 22 ].…”

“…More knowledge of specific risks for patients with cancer could guide physicians to make informed decisions on continuing oncological treatment and treatment restrictions in case of severe COVID-19. In the Netherlands, advanced care planning, including patient-clinician communication about end-of-life care, is well-established in clinical practice, especially in the elderly or patients with severe medical conditions, such as cancer [ 13 , 14 ]. End-of-life care communication comprises mainly decisions regarding life-prolonging treatment restrictions, such as do-not-resuscitate codes.…”

Introduction to special section: Living with Incurable Cancer: Addressing Gaps in Cancer Survivorship

“…Two studies address advance care planning (ACP) but differ in their results. Brazee et al [8] found limited documented discussions in medical records among women with metastatic breast cancer in one US institution and that these discussions are not equitably practiced, while Kroon et al [9] found that a majority of patients surveyed in the Netherlands reported being involved in ACP discussions and improve emotional well-being. It is important that we learn how such discussions have become standard of care in the Netherlands and disseminate these practices to the USA and other countries.…”

Early integrated palliative care in the acute care setting

“…So far, only a few studies explored patients' perception of and experience with an EPC intervention. [118][119][120] Maloney et al 118 found that patients with cancer benefited from a multicomponent telephone-based conversational intervention which enhanced their problem-solving abilities and feeling of empowerment to engage actively in their healthcare. They also felt supported and reassured by the intervention.…”

“…Patient involvement 118 in developing a structure such as SENS seemed to be essential. The SENS structure, developed in close partnership with patients and their family caregivers, resulted in a structure which is appreciated by both patients 4 and healthcare professionals 1 alike.…”