The impact of advance care planning on hope among patients with advanced cancer.

Abstract

12029 Background: Providers often cite a fear of “giving up hope” as a reason they defer advance care planning (ACP) among patients with advanced cancer. We sought to determine whether engagement in ACP impacts patient’s hope. Methods: This is a secondary analysis of a randomized controlled trial of primary palliative care in advanced cancer. Patients who had not completed ACP at baseline were included in the analysis. ACP was assessed in the forms of an end of life conversation with one’s oncologist (EOL conversation) and completion of a living will/advance directive (AD). Measurements were obtained at baseline and 3 months. Hope was measured using the Herth Hope Index (HHI, range 12-48, higher scores indicate higher hope). ACP was measured with patient responses to a validated ACP questionnaire that queried (1) if they had had an EOL conversation with their provider and (2) if they had completed a living will or advance directive. Multivariate regression was performed to control for baseline HHI score, study randomization and age, religious importance, education, marital status, socioeconomic status, time since cancer diagnosis, pain/symptom burden (ESAS), and anxiety/depression score (HADS)—all variables known to be associated with ACP and/or hope. Results: A total of 672 patients with advanced cancer were enrolled in the overall study. The mean age was 69±10, and the most common cancer types were lung (36%), GI (20%) and breast/GYN (16%). In this group, 378 (56%) had not had an EOL conversation at baseline, of whom 29% (111/378) reported having an EOL conversation by 3 months. Hope was not different between patients who had or did not have an EOL conversation over the study period (ΔHHI 0.20 ± 5.32 vs -0.53 ± 3.80, p=0.136). After multivariable adjustment, hope was significantly increased in patients who had engaged in an EOL conversation (adjusted mean difference in ΔHHI 0.95 (95%CI 0.08-1.82), p=0.032). Similarly, of 216 (32%) patients without an AD at baseline, 31% (67/216) patients had subsequently completed one. Unadjusted hope was not different between those who had and had not completed an AD (ΔHHI 0.20 ± 3.89 vs -0.91 ± 4.50, p=0.085). After adjustment, hope was significantly higher in those who completed an AD (adjusted mean difference in ΔHHI 1.31 (95%CI 0.13-2.49), p=0.030), (Table). Conclusions: Our results demonstrate that hope is not decreased after engagement in ACP and may, in fact, be increased. These findings may provide reassurance to providers who are apprehensive about having these important and difficult conversations. Unadjusted and adjusted change in hope for those patients who had and had not had completed an EOL conversation or AD.[Table: see text]