Aims: We sought to examine the acceptability and understanding of life-expectancy (LE) information in patients with advanced cancer participating in an RCT of a nurse-led advance care planning (ACP) intervention.
Methods: 209 patients with advanced cancer and an expected LE of 3-12 months were randomized to receive usual care or usual care plus ACP. At baseline, data was collected from oncologists estimating median LE (in months) for each patient. Participants in the ACP intervention group were offered individualized estimates of worst-case, typical and best-case scenarios for LE, based on their oncologist’s estimate. Patients’ understanding of their LE was recorded at baseline (pre-intervention) and again at 8 weeks (6 weeks post-intervention). Change in understanding of LE was calculated.
Results: The mean oncologist estimate of LE was 7.7 months (SD=2.9). At baseline 61.5% of patients did not know their likely estimated survival, 10% preferred not to answer this question and in 28% (n=56) the median estimate of LE was 12 months (SD=27.5). Only 18 of 105 patients in the intervention group (17%) chose to receive information on LE when offered by the ACP nurse. At 8 week follow-up, the accuracy of understanding of LE was not significantly different between the intervention and control groups (change score = -3.9 vs -2.45, p<0.718).
Conclusions: Prognostic information clarifies the focus and communication of goals of care, reducing the aggressiveness of EoL care1 and improving QoL for patients.2 Studies have demonstrated the acceptability of oncologist-lead interventions providing patients with tailored LE information, with subsequent improvement in patients’ understanding. However, the same was not true for our nurse-led intervention. The majority of patients in the intervention group chose not to receive information regarding LE and their understanding of LE post-intervention was not significantly different than the control group.