Advance Care Planning Completion and Decision-Making Among Older Adults With Cancer and Their Family Caregivers: Findings From a Mixed Methods Study

Abstract

Background

Advance care planning (ACP) is a complex process where individuals communicate decisions about their future health care before becoming incapable to participate in medical decision-making. While ACP has many potential benefits, little is known about ACP among older adults with cancer and their family caregivers. The purpose of this study is to examine holistic factors that affect ACP in older adults with cancer and how family caregivers engage in the process.

Methods

This study used explanatory sequential mixed methods design guided by Engel’s Biopsychosocial model. Phase I included secondary analysis of 1088 decedents over 55 years of age, using data from 2002-2016 waves of exit interviews of the Health and Retirement Study. Phase 2 included semi-structured interviews with a convenience sample of 14 family caregivers. Quantitative and qualitative findings were integrated using a joint display.

Results

Quantitative findings showed that over half of participants had all 3 types of ACP (end-of-life care discussion, durable power of attorney, advance directives) and all 3 types were significantly associated with age, race, education, multimorbidity, limitations in activities of daily living and instrumental activities of daily living, and marital status. Qualitative findings revealed that most participants had no knowledge about ACP. Integration identified points of convergence and divergence in knowledge, documentation, and factors affecting ACP.

Conclusions

Future studies are needed in a diverse sample of older adults with cancer and their family caregivers to understand and improve discussion and documentation of ACP. Findings also suggest the need for interventions to improve knowledge and awareness of ACP in this population.