Autonomy Preference Index and advance care planning preference of patients with incurable cancer and their association with anxiety and depression.

Abstract

54 Background: Shared decision-making and informed patient choices are promoted in many countries. However, advances in antitumoral treatments are making decisions and communication more complex and the benefit of early discussions on end-of-life care is still unclear, especially in most distressed patients. Using a validated French version of the Autonomy Preference Index (API), we studied the factors associated with the level of preference for participation in medical decision-making (DM), information seeking (IS) and advanced care planning (ACP) in patients with incurable cancer. Methods: The API is a self-administered scale that measures both dimensions of DM and IS on a 0 - 100 scale (100 for maximum participation and desire for information). DM is also assessed against the illness severity, using 3 clinical vignettes of specific diseases of increasing severity, each on a 0 - 10 scale. We designed another clinical vignette, questioning patient’s preference for discussion on “Do Not Resuscitate” order (ACP). 187 consecutive patients visiting the general oncology clinic of a university hospital completed the questionnaire, as well as the anxiety and depression HADS 14-points scales. Results: Patients were aged 65±12, 46% male, 39% with high school level of education. Lung (25%), colorectal (14%), pancreas (12%) ovarian (12%) were the most frequent types of cancer. 175 (95%) patients were receiving chemotherapy, 60 (33%) had anxiety, and 49 (26%) depression. Median (1st-3rdquartiles) of IS and DM were 45.8 (33.3-58.3), 85.4 (78.1-96.9) respectively. According to the ACP vignette, 177 (95%) patients considered important to discuss such decision with their doctor, 130 (71%) considered it possible, and 127 (68%) preferred to decide together with physician, or him/herself after taking physician’s advice. Female, most educated patients had higher DM score. We find no significant correlation between IS or DM scores and HADS. Conclusions: Incurable cancer patients have high expectations of medical information but intermediate or low level of preference for participation in decision making. However, they value the discussion on ACP to express their informed choice.