Practices and Perspectives of Clinicians Regarding Advance Care Planning With People Living With Cancer

Abstract

Background

While advance care planning (ACP) can facilitate a “good death” for people living with cancer, there remain gaps in understanding how to optimize ACP for better patient outcomes. This formative research aimed to explore experiences with advance care planning among oncology and primary care practitioners in primary/tertiary care settings.

Methods

The research team conducted structured and semi-structured in-depth interviews with family medicine practitioners (n = 12) and medical oncologists (n = 12) to understand their approaches to ACP.

Results

While oncologists and PCPs shared many of the same concerns about advance care planning, their unique contexts and specialties influenced their perspectives on the approach to ACP. Though oncologists and PCPs were both very likely to discuss ACP with their patients, oncologists more often discussed conducting ACP with other members of the health care team (e.g. social workers). Furthermore, disciplines differed in their emphasis on particular types of ACP documentation. Semi-structured interviews also revealed issues related to provider-patient communication as well as institutional challenges. Participants discussed their processes for timing the ACP conversation, addressing language-use challenges, assessing patient goals, and ensuring a good ACP workflow.

Conclusions

Participants recommended areas for institutional support and intervention to improve provider-patient ACP interactions.