Timing of advance care planning in patients with advanced cancer
Analysis of ACTION data
Tingting Zhu (Erasmus MC)
Judith AC Rietjens (Erasmus MC, TU Delft - DesIgning Value in Ecosystems)
Johannes J.M. van Delden ( University Medical Centre Utrecht)
Luc Deliens (Universiteit Gent, Vrije Universiteit Brussel)
Agnes van der Heide (Erasmus MC)
Anna Thit Johnsen (Zealand University Hospital)
Francesca Ingravallo (University of Bologna)
Urška Lunder (University Clinic of Respiratory and Allergic Diseases Golnik)
Nancy J. Preston (Lancaster University)
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Abstract
Objective
To explore the experiences of patients with advanced cancer regarding the timing of ACP.
Methods
This secondary analysis used data from the ACTION cluster-randomized clinical trial. 288 patients with advanced lung or colorectal cancer, WHO performance status 0–3, and with a minimum life expectancy of 3 months were included in this analysis.
Results
The mean time between patients’ cancer diagnosis and the first ACP conversation was 15.3 months (SD:19.4). The average duration from current cancer stage diagnosis to the first conversation was 8.9 months (SD:10.7). The timing of the conversation was perceived as “just right” by 217 (75.3 %) of the patients. Patients who perceived the timing as “too early” were more recently diagnosed with cancer (9.1 months) or with their current cancer stage (5.7 months) than those who did not. Patients perceiving the timing as “too late” had shorter estimated survival times.
Conclusion
Patients with advanced cancer may benefit from earlier ACP than what is currently typically initiated in clinical practice.
Practice implications
When initiating ACP conversations, several aspects should be considered, including patients’ gender, their socio-cultural environment, and their ability to perform daily activities, with or without limitations.
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