A mixed methods analysis of patients’ advance care planning values in outpatient oncology: Person-Centered Oncologic Care and Choices (P-COCC)

Abstract

Purpose-Person-Centered Oncologic Care and Choices (P-COCC) combines an advance care planning (ACP) value-focused patient interview with a care goal video decision aid. Our randomized study showed that P-COCC was acceptable but increased participant distress, compared with video-alone and usual care study arms. This mixed methods approach explores the ACP values in the P-COCC arm and their relationship to the distress phenomenon. Methods-Qualitative thematic analysis of the 46 audio-recorded P-COCC interview transcripts with advanced gastrointestinal cancer patients was performed by multiple reviewers. Quantitative (Likert scale) changes in ACP values were compared across study arms. ACP themes and value change were analyzed in participants with increased distress. Results-Transcript analysis resulted in thematic saturation and identified eight distinct themes on ACP values relating to end-of-life wishes, communication needs, and psychosocial supports. Of 98 participants (33 P-COCC, 43 videos, 22 usual care) who completed the change in value measure, there was no difference detected with P-COCC compared with either video (p =0.052) or usual care (p = 0.105) arms alone, but P-COCC led to a frequency distribution of more change in personal values compared with the other study arms combined (p = 0.043). Among the subset of P-COCC participants with increased distress, there was no statistical relationship with change in values. Conclusions-The ACP paradigm P-COCC both informs and supports patients in individualized, value-based decision-making. Distress is not associated with changes in ACP

Impact of advance care planning and end‐of‐life conversations on patients with cancer: An integrative review of literature

“…The study results demonstrated increased distress (0.43) in the P‐COCC arm as compared to the video only arm (−0.04). The increased distress was noted again by Agarwal et al (2020) in their mixed method study that explored ACP values with a survey of the same study patients of the P‐COCC intervention arm ( n = 33). There was a reduction in anxiety and depression in the study population of Agarwal et al, 2020; Epstein et al, 2018.…”

“…Agarwal et al (2020) found a close relationship between distress associated with the CPR video and cancer patients' end‐of‐life preferences with less aggressive care and choosing no CPR at the end‐of‐life. The video provided most participants with sufficient information to make an informed decision to make EOL care decisions.…”

“…This integrated review of the literature revealed that advance care planning conversations had a positive impact on cancer patients' experience as reflected by a decrease in anxiety and depressive symptoms (Agarwal et al, 2020; Bernacki et al, 2019; Epstein et al, 2018; Paladino et al, 2020; Tang et al, 2019), increased awareness about the disease and prognosis (Agarwal et al, 2020; Kumar et al, 2020; Michael et al, 2015; Rodenbach et al, 2017; Walczak et al, 2017; Yoo et al, 2020), increased decision making about end‐of‐life care preferences (Agarwal et al, 2020; Brohard, 2017; Epstein et al, 2015; Tang et al, 2019).…”

“…Epstein et al (2018) intervention arm (n = 33). There was a reduction in anxiety and depression in the study population of Agarwal et al, 2020;Epstein et al, 2018. Additionally, the results of three studies (Bernacki et al, 2019;Paladino et al, 2020;Tang et al, 2019) Prognostic awareness and understanding of future health care Seven studies found ACP improved cancer patients' prognostic awareness and enhanced their understanding of future care. A qualitative study by Kumar et al (2020) to understand patients' perceptions of ACP focused on goals and values conversations using a structured guide, followed by a survey and interview completed by (n = 32) cancer patients that showed that 55% of the (n = 32) patients reported increased understanding of future health and improved prognostic awareness.…”

“…The advancing strength and clinical practice model were used to assess the methodological strength of the evidence (Melnyk & Fineout‐Overholt, 2019). The strength of evidence among the studies varied and is consistent with level II ( n = 4) randomized control trials (Bernacki et al, 2019; Epstein et al, 2018; Tang et al, 2019; Walczak et al, 2017), level III ( n = 2) non‐randomized control trial (Brohard, 2017; Rodenbach et al, 2017), level VI ( n = 2) descriptive studies (Stegmann et al, 2020; Yoo et al, 2020), ( n = 5) qualitative studies (Epstein et al, 2015; Geerse et al, 2019; Kumar et al, 2020; Paladino et al, 2020; Toguri et al, 2020), and ( n = 2) mixed method studies (Agarwal et al, 2020; Michael et al, 2015).…”