Advanced pancreas and hepatobiliary (PHB) cancer patients’ impressions regarding cardiopulmonary resuscitation (CPR).

Abstract

e20586 Background: Most cancer patients desire information about medical options at the end of life, including CPR. Such communication is part of advance care planning (ACP). Our prior studies with video educational media have produced data on patients’ categoric preferences (yes/no/unsure) for CPR, however, the thematic underpinnings of these preferences in patients with advanced cancer are not known. Methods: Qualitative thematic content analyses were performed on participants’ verbatim responses to the question “Do you have any questions or concerns?” at the end of participating in a randomized trial (quantitative data reported in full, Epstein, ASCO 2012) of an educational video (V) or narrative (N) about CPR in patients with advanced PHB cancers. Participant responses were independently coded and categorized for thematic content by two reviewers (ASE, ES). To maximize internal validity, reviewers jointly compared and reconciled differences in analyses. Results: Of 54 study participants, 26 total (41% of V arm, 56% of N arm) articulated questions, comments, or both. From these 26, 1-3 (median=1) themes were generated from each participant. There were no appreciable differences in the content or number of themes between the N and V arms. Joint analysis demonstrated thematic consensus and resulted in seven distinct themes listed in decreasing order of prevalence: (1) information about CPR affirmed existing personal beliefs/knowledge/values (many wanted to forgo CPR); (2) participants were apprehensive about ACP but wanted to discuss it; (3) ACP should be started early; (4) CPR information was helpful/acceptable; (5) physicians should be involved in ACP; (6) gaps in knowledge emerged; and (7), medical questions arose. Conclusions: The comments of these advanced PHB cancer patients demonstrate receptivity to the topic of ACP despite it being hard to discuss. These data indicate that ACP is a helpful and desired process ideally begun early by clinicians, and that video education is an appropriate and affirming conversation starter. The themes generated here will be incorporated into our future ACP studies on the relationships between cancer patient values and education about care options. Clinical trial information: NCT01105806.