CN28 - From difficulty to meaning: Palliative cancer patients experience on advance care planning conversation and having a palliative plan

Background

ACP is used as a systematic tool with the aim of helping patients establish decisions about future care. Palliative care plan is a document that aims to ensure the planning and facilitation of measures to give patients and their families safety and the best possible quality of life. The plan was implemented in several municipalities in North-western of Norway in the first half of 2018 and follows the patient at all service levels.

Methods

An exploratory qualitative study was conducted with five palliative cancer patients who had undergone ACP and prepared a palliative plan. Strategic selection was used to choose informants and participants were recruited from four municipalities. Data were collected through individual semi-structured interviews and were analyzed using Malteruds systematic text condensation.

Results

Patients experienced ACP as a process starting from difficult conversations and culminating in a sense of meaning. Having a palliative care plan was felt to be a positive aspect, but they wished they had been prepared for these conversations and had undergone ACP in their own home. The patients’ insights were as follows: (1) The starting point was difficult for the patients since they had to talk about cancer and death, which was tough, painful, and rather “taboo” topics. (2) The interactions with the doctor/nurse helped the patients feel valued and involved and underlined their final wishes. The patients wished that their next of kin had been involved by the doctor/nurse. (3) Preparing a plan for the future and death was a meaningful process for the patients and gave them a sense of security.

Conclusions

Results suggest that advance discussion and a comprehensive plan are shown to give palliative cancer patients much benefit. Although participation in ACP can arouse unpleasant feelings, many patients reported benefits from it. Getting their wishes to be known and the reduced personal information about themselves in a document, gives patients inner peace of mind and increases quality of life. The context and interactions provided by the doctor/nurse, their ability in communicating with the patients, including the patients as persons and taking care of the patient's values and wishes was crucial.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Norwegian University of Science and Technology.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.