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Content analysis of Advance Directives completed by patients with advanced cancer as part of an Advance Care Planning intervention : insights gained from the ACTION trial

(2020) SUPPORTIVE CARE IN CANCER. 28(3). p.1513-1522
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Organization
Abstract
Purpose Writing an Advance Directive (AD) is often seen as a part of Advance Care Planning (ACP). ADs may include specific preferences regarding future care and treatment and information that provides a context for healthcare professionals and relatives in case they have to make decisions for the patient. The aim of this study was to get insight into the content of ADs as completed by patients with advanced cancer who participated in ACP conversations. Methods A mixed methods study involving content analysis and descriptive statistics was used to describe the content of completed My Preferences forms, an AD used in the intervention arm of the ACTION trial, testing the effectiveness of the ACTION Respecting Choices ACP intervention. Results In total, 33% of 442 patients who received the ACTION RC ACP intervention completed a My Preferences form. Document completion varied per country: 10.4% (United Kingdom), 20.6% (Denmark), 29.2% (Belgium), 41.7% (the Netherlands), 61.3% (Italy) and 63.9% (Slovenia). Content analysis showed that 'maintaining normal life' and 'experiencing meaningful relationships' were important for patients to live well. Fears and worries mainly concerned disease progression, pain or becoming dependent. Patients hoped for prolongation of life and to be looked after by healthcare professionals. Most patients preferred to be resuscitated and 44% of the patients expressed maximizing comfort as their goal of future care. Most patients preferred 'home' as final place of care. Conclusions My Preferences forms provide some insights into patients' perspectives and preferences. However, understanding the reasoning behind preferences requires conversations with patients.
Keywords
Advance Directive, Advance Care Planning, Cancer, Content analysis, End of life, QUALITATIVE-ANALYSIS, DECISION-MAKING, PREVALENCE, FREQUENCY, ATTITUDES, OUTCOMES, DISEASE, VIEWS

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MLA
Zwakman, Marieke, et al. “Content Analysis of Advance Directives Completed by Patients with Advanced Cancer as Part of an Advance Care Planning Intervention : Insights Gained from the ACTION Trial.” SUPPORTIVE CARE IN CANCER, vol. 28, no. 3, 2020, pp. 1513–22, doi:10.1007/s00520-019-04956-1.
APA
Zwakman, M., van Delden, J., Caswell, G., Deliens, L., Ingravallo, F., Jabbarian, L., … Kars, M. (2020). Content analysis of Advance Directives completed by patients with advanced cancer as part of an Advance Care Planning intervention : insights gained from the ACTION trial. SUPPORTIVE CARE IN CANCER, 28(3), 1513–1522. https://doi.org/10.1007/s00520-019-04956-1
Chicago author-date
Zwakman, Marieke, JJM van Delden, G Caswell, Luc Deliens, F Ingravallo, LJ Jabbarian, AT Johnsen, et al. 2020. “Content Analysis of Advance Directives Completed by Patients with Advanced Cancer as Part of an Advance Care Planning Intervention : Insights Gained from the ACTION Trial.” SUPPORTIVE CARE IN CANCER 28 (3): 1513–22. https://doi.org/10.1007/s00520-019-04956-1.
Chicago author-date (all authors)
Zwakman, Marieke, JJM van Delden, G Caswell, Luc Deliens, F Ingravallo, LJ Jabbarian, AT Johnsen, IJ Korfage, A Mimić, C Møller Arnfeldt, NJ Preston, and MC Kars. 2020. “Content Analysis of Advance Directives Completed by Patients with Advanced Cancer as Part of an Advance Care Planning Intervention : Insights Gained from the ACTION Trial.” SUPPORTIVE CARE IN CANCER 28 (3): 1513–1522. doi:10.1007/s00520-019-04956-1.
Vancouver
1.
Zwakman M, van Delden J, Caswell G, Deliens L, Ingravallo F, Jabbarian L, et al. Content analysis of Advance Directives completed by patients with advanced cancer as part of an Advance Care Planning intervention : insights gained from the ACTION trial. SUPPORTIVE CARE IN CANCER. 2020;28(3):1513–22.
IEEE
[1]
M. Zwakman et al., “Content analysis of Advance Directives completed by patients with advanced cancer as part of an Advance Care Planning intervention : insights gained from the ACTION trial,” SUPPORTIVE CARE IN CANCER, vol. 28, no. 3, pp. 1513–1522, 2020.
@article{8622817,
  abstract     = {Purpose Writing an Advance Directive (AD) is often seen as a part of Advance Care Planning (ACP). ADs may include specific preferences regarding future care and treatment and information that provides a context for healthcare professionals and relatives in case they have to make decisions for the patient. The aim of this study was to get insight into the content of ADs as completed by patients with advanced cancer who participated in ACP conversations. Methods A mixed methods study involving content analysis and descriptive statistics was used to describe the content of completed My Preferences forms, an AD used in the intervention arm of the ACTION trial, testing the effectiveness of the ACTION Respecting Choices ACP intervention. Results In total, 33% of 442 patients who received the ACTION RC ACP intervention completed a My Preferences form. Document completion varied per country: 10.4% (United Kingdom), 20.6% (Denmark), 29.2% (Belgium), 41.7% (the Netherlands), 61.3% (Italy) and 63.9% (Slovenia). Content analysis showed that 'maintaining normal life' and 'experiencing meaningful relationships' were important for patients to live well. Fears and worries mainly concerned disease progression, pain or becoming dependent. Patients hoped for prolongation of life and to be looked after by healthcare professionals. Most patients preferred to be resuscitated and 44% of the patients expressed maximizing comfort as their goal of future care. Most patients preferred 'home' as final place of care. Conclusions My Preferences forms provide some insights into patients' perspectives and preferences. However, understanding the reasoning behind preferences requires conversations with patients.},
  author       = {Zwakman, Marieke and van Delden, JJM and Caswell, G and Deliens, Luc and Ingravallo, F and Jabbarian, LJ and Johnsen, AT and Korfage, IJ and Mimić, A and Møller Arnfeldt, C and Preston, NJ and Kars, MC},
  issn         = {0941-4355},
  journal      = {SUPPORTIVE CARE IN CANCER},
  keywords     = {Advance Directive,Advance Care Planning,Cancer,Content analysis,End of life,QUALITATIVE-ANALYSIS,DECISION-MAKING,PREVALENCE,FREQUENCY,ATTITUDES,OUTCOMES,DISEASE,VIEWS},
  language     = {eng},
  number       = {3},
  pages        = {1513--1522},
  title        = {Content analysis of Advance Directives completed by patients with advanced cancer as part of an Advance Care Planning intervention : insights gained from the ACTION trial},
  url          = {http://dx.doi.org/10.1007/s00520-019-04956-1},
  volume       = {28},
  year         = {2020},
}

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