The Prevalence and Types of Advance Care Planning Use in Patients with Advanced Cancer: A Retrospective Single-Centre Perspective, Australia

Abstract

Background: Advance Care Planning (ACP) has been reported to be of value in maintaining patients’ autonomy and dignity; reducing patient and family anxiety; improving end-of-life care and reducing futile interventions. But in Australia participation rate in advance care directives is 14%, and research is limited on ACP invitations and uptake among the patients with advanced cancer (PwAC). This study identifies the prevalence and types of documented ACP discussions in PwAC who died within two or four weeks of receiving chemotherapy. Methods: A retrospective audit was conducted in Gold Coast University Hospital, Australia, and the records of 339 patients were examined and 320 patients were found eligible. Descriptive statistics were calculated in SPSS. The difference in ACP invitation and utilisation between three groups [control, <2-weeks, and –4 weeks] was measured by the Kruskal-Wallis test and Chi-square (or Fisher-Exact) test. Post-hoc follow-up pair-wise comparisons were performed. Adjusted prevalence ratios were estimated using two logistic regression models, and the significance of the coefficients was assessed using Wald test. Results: Of the 320 PwAC [male: 55%; median age: 65 years], 227 (71%) received ACP invitation, and among the invited patients, 89% used Acute Resuscitation Plan; 54% used Enduring Power-of-Attorney; and 20% completed Advance Health Directive. From 7.5% [n=24] of the patients who received chemotherapy in their last 2-weeks of life, 42% had not received an ACP invitation, 29% didn’t have Acute Resuscitation Plan and only 4% completed Advance Health Directive. There were significant differences among the Control, <2-weeks, and 2–4 weeks groups in completing Acute Resuscitation Plan (p=0.003) and Advance Health Directives (p=0.045). A significant difference was also observed between control and <2-weeks groups in number of days since Acute Resuscitation Plan used. Completing an Acute Resuscitation Plan was associated with a lower risk of dying within two-weeks of chemotherapy (OR=0.246; p=0.008). Conclusions: The low rates of ACP invitation and use in PwAC, especially who received chemotherapy in 2-weeks of dying confirm a need of embedding and regular revisiting the ACP framework in cancer care and educating staff, patients, and their family caregivers to increase the uptake.