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Understanding how cancer patients actualise, relinquish, and reject advance care planning: implications for practice
- Source :
- Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 21(8)
- Publication Year :
- 2012
-
Abstract
- Although advance care planning (ACP) is recognised as integral to quality cancer care, it remains poorly integrated in many settings. Given cancer patients’ unpredictable disease trajectories and equivocal treatment options, a disease-specific ACP model may be necessary. This study examines how Australian cancer patients consider ACP. Responses will inform the development of an Australian Cancer Centre’s ACP programme. A constructivist research approach with grounded theory design was applied. Eighteen adults from lung and gastro-intestinal tumour streams participated. Participants first described their initial understanding of ACP, received ACP information, and finally completed a semi-structured interview assisted by the vignette technique. Qualitative inter-rater reliability was integrated. Participants initially had scant knowledge of ACP. On obtaining further information, their responses indicated that: For cancer patients, ACP is an individualised, dynamic, and shared process characterised by myriad variations in choices to actualise, relinquish, and/or reject its individual components (medical enduring power of attorney, statement of choices, refusal of treatment certificate, and advanced directive). Actualisation of each component involves considering, possibly conversing about, planning, and communicating a decision, usually iteratively. Reactions can change over time and are informed by values, memories, personalities, health perceptions, appreciation of prognoses, and trust or doubts in their substitute decision makers. Findings endorse the value of routinely, though sensitively, discussing ACP with cancer patients at various time points across their disease trajectory. Nonetheless, ACP may also be relinquished or rejected and ongoing offers for ACP in some patients may be offensive to their value system.
- Subjects :
- Advance care planning
Adult
Male
Palliative care
Decision Making
Psychological intervention
Models, Psychological
Trust
Grounded theory
Advance Care Planning
stomatognathic system
Nursing
Power of attorney
Neoplasms
Medicine
Humans
Aged
business.industry
Nursing research
Communication
Australia
Reproducibility of Results
Middle Aged
Directive
humanities
Oncology
Vignette
Female
business
Advance Directives
Subjects
Details
- ISSN :
- 14337339
- Volume :
- 21
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
- Accession number :
- edsair.doi.dedup.....83bab62bf4431da8314641d9a2ff993a