Barriers and Facilitators to Advance Care Planning among Chinese Patients with Advanced Cancer and Their Caregivers

Jia, Z.; Yeh, Irene; Lee, Caroline H; Yeung, Albert; Tulsky, James A.; Leiter, Richard E.

doi:10.1089/jpm.2021.0404

Cited by 20 publications

(37 citation statements)

References 49 publications

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“…Similar findings have previously been shown in Asian countries (Martina et al 2021). Studies have also highlighted that Asian patients lack readiness in engaging with ACP conversations (Jia et al 2022). Additionally, non-physician HCPs reported lack of confidence and knowledge to facilitate ACP conversations.…”

Section: Howardsupporting

confidence: 80%

Barriers to advance care planning among patients with advanced serious illnesses: A national survey of health-care professionals in Singapore

Malhotra

Chaudhry

2023

Pall Supp Care

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Objectives To assess the barriers that health-care professionals (HCPs) face in having advance care planning (ACP) conversations with patients suffering from advanced serious illnesses and to provide care consistent with patients’ documented preferences. Methods We conducted a national survey of HCPs trained in facilitating ACP conversations in Singapore between June and July 2021. HCPs responded to hypothetical vignettes about a patient with an advanced serious illness and rated the importance of barriers (HCP-, patient-, and caregiver-related) in (i) conducting and documenting ACP conversations and (ii) providing care consistent with documented preferences. Results Nine hundred eleven HCPs trained in facilitating ACP conversations responded to the survey; 57% of them had not facilitated any in the last 1 year. HCP factors were reported as the topmost barriers to facilitating ACP. These included lack of allocated time to have ACP conversations and ACP facilitation being time-consuming. Patient’s refusal to engage in ACP conversations and family experiencing difficulty in accepting patient’s poor prognosis were the topmost patient- and caregiver-related factors. Non-physician HCPs were more likely than physicians to report being fearful of upsetting the patient/family and lack of confidence in facilitating ACP conversations. About 70% of the physicians perceived caregiver factors (surrogate wanting a different course of treatment and family caregivers being conflicted about patients’ care) as barriers to providing care consistent with preferences. Significance of results Study findings suggest that ACP conversations be simplified, ACP training framework be improved, awareness regarding ACP among patients, caregivers, and general public be increased, and ACP be made widely accessible.

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Section: Howardsupporting

confidence: 80%

Barriers to advance care planning among patients with advanced serious illnesses: A national survey of health-care professionals in Singapore

Malhotra

Chaudhry

2023

Pall Supp Care

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“…Several predisposing, not easily modifiable, factors and barriers related to ACP uptake in the cancer care context were identified. Recent studies highlighted the roles of cultural, and religious factors and the need to consider minority groups’ preferences when assessing the appropriateness of ACP [16,18–22]. These findings are in line with those of a recent review of ACP uptake among older adults with cancer [13 ▪▪ ].…”

Section: Advance Care Planning Uptake-predisposing Factors and Barrierssupporting

confidence: 76%

“…Thirty-eight studies [15–52] and three reviews were identified [6 ▪ ,8 ▪▪ ,13 ▪▪ ]. Studies were heterogeneous in terms of cancer care contexts, population size and characteristics, research designs, and assessment methods (Table 1).…”

Section: Literature Search and Samplementioning

confidence: 99%

“…Factors associated with ACP communication were allocated to five categories (based on ACP uptake [13 ▪▪ ] and communication in healthcare [14] models): ACP uptake-predisposing factors and barriers [15–23], ACP uptake-enabling factors and barriers [15,18,24,25,26 ▪ ,27–29], perceived need for ACP communication and barriers [15], ACP communication–enabling factors and barriers [17,18,23,25,26 ▪ ,30–38], and willingness to communicate about ACP [23,30–32]. Fourteen articles that were not included in these categories are reported in Table 1.…”

Section: Overview Of Factors Influencing Advance Care Planning Commun...mentioning

confidence: 99%

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Advance care planning in oncology: a scoping review and some recommendations

Libert,

Choucroun,

Razavi

et al. 2023

Current Opinion in Oncology

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Purpose of reviewCancer patients' communication with their relatives and healthcare professionals (HCPs) is essential for advance care planning (ACP). The purpose of this scoping review was to synthesize recent research findings about factors enabling cancer patients', their relatives', and physicians' communication about ACP, and to propose recommendations for future ACP implementation in cancer care. Recent findingsThis review confirmed the importance of aspects of the cancer care context (i.e., culture) as ACP uptakepredisposing and -enabling factors. It highlighted the difficulty of determining who should initiate ACP discussion, with which patients and at what time-points. It also highlighted a lack of consideration for socioemotional processes in the study of ACP uptake despite evidence that cancer patients', relatives' and physicians' discomforts that arise from communication about end-of-life and the wish to safeguard each other are main obstacles to ACP implementation.

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“…Lack of engagement inhibits access to implications of available treatment options, impacting decision-making and conversations about what patients consider a priority in their current and future care. 4,5 The main difficulties in discussing ACP are the prognosis acceptance and the desire for aggressive measures due to high expectations of treatment benefits. Professionals also demonstrate barriers ( ie , limited time, prognostic estimation uncertainty, and doubts about treatment benefits), but they are less impacting when compared to those of patients and family members.…”

Section: Introductionmentioning

confidence: 99%

Comprehension and Decision-Making Capacity Questionnaire About Palliative Care and Advance Care Planning: A Delphi Study

Trevizan

Paiva

Julião³

et al. 2022

J Palliat Care

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Objective(s) To develop a questionnaire that assesses the level of comprehension and decision-making capacity of patients with breast cancer about palliative care and advance care planning. Methods: Questionnaire items were based on the scientific literature. Delphi Consensus, a three-round survey with experts (n = 14), evaluated the relevance, clarity, and redundancies of the items. A pretest with breast cancer patients (n = 15) evaluated whether they comprehended each item and identified doubts or discomforts. Results: The initial questionnaire was composed of 38 items. After the Delphi, 18 items were restructured, six were added, and 16 were removed. In the pretest phase, all items with the survey header, guidelines, and Likert model were evaluated. All items accomplished ≥80% cut-off score and were kept as in the original version. The final version of the questionnaire have 28 itens and five domains: determination, responsibility, independence, self-knowledge, and knowledge of reality. Conclusions: This study represents the first step in the development of a questionnaire that may be used in oncology clinical practice. The main findings revealed that Delphi and pretesting increased the quality of the questionnaire, making it compelling to assess breast cancer patients’ comprehension and decision-making capacity about PC and ACP.

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Barriers and Facilitators to Advance Care Planning among Chinese Patients with Advanced Cancer and Their Caregivers

Cited by 20 publications

References 49 publications

Barriers to advance care planning among patients with advanced serious illnesses: A national survey of health-care professionals in Singapore

Barriers to advance care planning among patients with advanced serious illnesses: A national survey of health-care professionals in Singapore

Advance care planning in oncology: a scoping review and some recommendations

Comprehension and Decision-Making Capacity Questionnaire About Palliative Care and Advance Care Planning: A Delphi Study

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