Purpose: To determine the frequency of advance care planning (ACP) in hospitalized cancer patients and to assess their reactions to a proposed policy in which medical housestaff would
offer to discuss ACP at the time of hospital admission.
Methods: Structured interviews with 111 consecutively admitted cancer patients on the oncology inpatient service of a tertiary care medical center.
Results: We found that 69% (77/111) of patients had discussed their advance care preferences with someone, usually a family member, and 33% (37/111) had completed at least one
formal advance directive (e.g., a living will or durable power of attorney for health care); 32%
(36/111) had done both; and 30% (33/111) had done neither. However, only 9% (10/111) of patients
reported having discussed their advance care preferences with their clinic oncologists
and only 23% (23/101) of the remaining patients stated that they wished to do so. By contrast,
58% (64/110) of patients supported a policy in which medical housestaff would offer to discuss
these advance care preferences as a part of the admission history.
Conclusions: Our data suggest that while oncology inpatients frequently have ACPs that
they discuss with family and/or document in formal advance directives, they rarely discuss
or wish to discuss these ACPs with clinic oncologists. We also show that most of the reticent
patients would nevertheless consider discussing the same ACPs with admitting housestaff
on the day of hospital admission.
