Assessing patient values first: Creating a platform for advance care planning (ACP) in the adult oncology population.

Abstract

99 Background: Patients, families and healthcare providers can be apprehensive about having end-of-life (EOL) conversations. However, asking patients about personal values regarding their healthcare goals may create a platform for more in depth conversations. A quantitative instrument to assess patient values and ACP readiness was developed and validated to complement a process for identifying patients appropriate for ACP. Methods: Recruitment was conducted at seven cancer center sites in The US Oncology Network over a 90-day pilot study period. Of 871 identified patients, 301 Texas Oncology patients engaged in ACP. A cross-sectional descriptive design was used in 301 metastatic cancer patients. Sixty-three participants completed the questionnaire. The 13-item instrument was created after an extensive literature review regarding EOL choices and interventions using a 5-point Likert scale. Descriptive statistics were examined, in addition to analysis of the relationships between items using Pearson’s r correlations. Results: Participants were primarily female (59%) and Caucasian (95%); with a mean age of 66 years. Sixty-eight percent reported it "Very Important" to be told they were dying. There was a significant association between willingness to discuss feelings about dying and being told by their physician when dying, (r= 0.373, p<0.01). Sixty-two percent reported it "Very Important" to be able to choose their EOL care location. EOL care location and level of burden for caregivers were significantly associated (r= 0.315, p<0.05). Also, 76% reported being able to select the person who makes EOL decisions for them as "Very Important." Conclusions: Recent studies have shown the importance of assessment of patient healthcare values in the metastatic oncology population. The values and readiness instrument allows healthcare providers to understand the patient’s wishes early in the course of care. ACP can be guided through review of the validated instrument in the adult metastatic population. This provides appropriate weight to both sides of the care equation and is a major step toward creating patient-centered care. Further development of the instrument is needed in this population.