Advance care planning in primary care for cancer patients: Feasibility randomised trial

Anne Canny*, Bruce Mason, Jacqueline Stephen, Samantha Hopkins, Lucy Wall, Alan Christie, Richard Skipworth, Joanna Bowden, Louise Graham, Marilyn Kendall, Christopher J Weir, Kirsty Boyd

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Advance (anticipatory) care planning (ACP) requires discussions between patients and healthcare professionals about planning for future deterioration in health. ACP improves care coordination but uptake is limited and often deferred.

AIM: To assess the feasibility and acceptability to patients, carers, and GPs of a primary care ACP intervention for people with incurable oesophageal, gastric, or pancreatic cancer.

DESIGN AND SETTING: A 12-month feasibility randomised controlled trial (RCT) in a Scottish Cancer Network.

METHOD: Patients aged ≥18 years starting palliative oncology treatment were randomised 1:1 to an ACP intervention or standard care. Patients in the intervention group received an oncologist letter supporting them to request a GP review along with a patient information leaflet about ACP. Pre-specified analyses with masking included trial recruitment and retention, ACP completion, and quality-of-life questionnaires (EuroQol EQ-5D-5L and ICECAP Supportive Care Measure) at baseline, 6, 12, 24, and 48 weeks. Qualitative interviews with purposive sampling explored patient, carer, and GP experiences.

RESULTS: Of 99 eligible participants (269 screened), 46% were recruited ( n = 46) and randomised; 25 to intervention and 21 to control. By 12 weeks, 45% ( n = 9/20) of the individuals in the intervention and 59% ( n = 10/17) in the control group had a documented ACP plan. By 24 weeks, 30% ( n = 14) had died; in the remaining participants quality of life was maintained at 24 weeks except for physical symptoms. Social norms associating ACP with dying were prevalent among 23 participants interviewed. No psychological or clinical harms were identified.

CONCLUSION: An RCT of ACP for people with incurable cancer in primary care is feasible. Patient, carer, and GP attitudes and behaviours determined acceptability and timing of care planning.

Original languageEnglish
Article numberBJGP.2021.0700
Pages (from-to)e571-e580
JournalBritish Journal of General Practice
Volume72
Issue number721
Early online date28 Jul 2022
DOIs
Publication statusPublished - 1 Aug 2022

Keywords

  • advance care planning
  • anticipatory care planning
  • primary health care
  • cancer
  • general practice
  • mixed methods research

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