Oral Presentation Joint 2016 COSA and ANZBCTG Annual Scientific Meeting

Advance care planning increases communication between cancer patients, their oncologists and their family: an RCT (#97)

Stephanie Johnson 1 , Lisa Vaccaro 1 , Phyllis N Butow 1 , Belinda E Kiely 1 2 , William Silvester 3 , Karen Detering 3 , Josephine Clayton 1 , Stephen Clarke 4 , Martin NH Tattersall 1
  1. Univeristy of Sydney, Camperdown, NSW, Australia
  2. The Macarthur Cancer Centre, Sydney, NSW
  3. Austin Health, Heidelberg, Victoria
  4. The Royal North Shore Hospital, Sydney, NSW

Aims: To measure the impact of an advance care planning intervention (ACP) on communication about end of life care (EOLC) with healthcare professionals and family, in patients with incurable cancer.

Methods: 209 patients with advanced cancer and an expected survival of 3-12 months, as well as their nominated family or friend, were randomised to receive usual care or usual care plus ACP.  Communication with healthcare providers and family members was assessed by questionnaire at baseline and 8 weeks (6weeks post-intervention) using a 5-point likert scale (‘Not at all’ to ‘Very much’ discussion). Participants were asked “have you made any decisions regarding the types of medical treatments you would wish to receive if you are very sick?’ and “have you written these wishes down in a formal way?”.

Statistical methods: Univariate analysis using chi-squared tests for categorical outcomes and independent t-tests for continuous outcomes. Differences between groups at 8 weeks and change scores between time points, are reported.

Results: At baseline 15 (7%) participants had formally documented their wishes for future care. Only 52 (26.1%) participants reported communicating with their oncologists regarding their wishes for future care and 114 (54.5%) reported communicating with their family members. At 8 weeks (n=144) the intervention group were significantly more likely than the control group to have documented their wishes (64.2% vs 13%, P< 0.000). Communication with oncologists increased to 47.8% in the ACP group, compared to 27.3% in control (P <0.011) (Intervention group change score 0.41, P< 0.049). At 8 weeks the intervention group were also more likely to report communication with their family members (92.4% vs 68.8%, P.< 0.000), (Intervention group change score 1.28, P < 0.000).

Conclusions: The intervention increased documentation of patient’s wishes for EOLC and increased communication with oncologists and family.