Advance care planning, cancer, congruence
Patients with life-limiting cancer and their families face unique challenges that interfere with their ability to make decisions or adequately express their health care preferences about end of life (EOL) treatment. As a result, patients at EOL often receive aggressive unwanted treatment that nationally costs billions of dollars and results in surrogate distress about not honoring patient wishes. Respecting Choices® DS-ACP is a disease-specific Advance Care Planning (ACP) intervention that is designed to overcome barriers associated with ACP and potentially decrease the incidence of unwanted, overly aggressive treatments at EOL. The intervention is delivered to patient-surrogate dyads by a trained facilitator who provides an opportunity for patients to identify values and goals that support their EOL choices and communicate these values and goals to their surrogates before they are in a medical crisis. Although Respecting Choices® DS-ACP has been effective with other populations, it has not been evaluated for patients with life-limiting cancer. Thus, the purpose of this study was to evaluate the Respecting Choices® DS-ACP intervention with patients with life-limiting cancer to determine if the intervention increases patient-surrogate congruence about the patient's EOL wishes and reduces decisional conflict without causing anxiety. Study design was a Phase I clinical trial. A volunteer sample of 15 patients with a diagnosis of life limiting cancer and their matched surrogates participated in the study. The Statement of Treatment Preferences for Life-Limiting Cancer Form, the Spielberger Stateanxiety Scale Form Y-1 (STAI) and the Decisional Conflict Scale (DCS) were administered preand post-intervention. The Quality of Communication about End of Life Care Form was administered at post test. Descriptive statistics were used to describe the sample. McNemar Chisquare and Binomial tests were conducted to investigate whether the intervention increased iv congruence for five different situations on the Statement of Treatment Preferences for LifeLimiting Cancer Form. The Zar’s Multiple Comparison Test of Differences was conducted to investigate the proportion of congruence observed across the five situations. A paired-sample t test was conducted to evaluate post-intervention changes in anxiety (STAI) and decisional conflict (DCS). Frequencies and percentages were conducted for the five items on the Quality of Communication about End of Life Care Form to evaluate patients' and surrogates' satisfaction with the intervention. Anecdotal comments about timing were content analyzed and summarized. Congruence between patients and surrogates improved significantly in all five situations (range of p =.001 to .031), decisional conflict lessened significantly (t (14) =4.49, p < .001), and anxiety did not change (t (14) = 1.75, p = .102) pre- and post-intervention. Participants reported satisfaction with the intervention, including its delivery and timing. Findings from this study provide guidance on how to assist patients with life limiting cancer and their surrogates with EOL decision making. Study findings also support making the Respecting Choices ACP intervention part of usual care for patients with life limiting cancer and timing the intervention so that it is delivered before a medical crisis occurs. The lack of change in post-intervention anxiety scores suggests that ACP does not add to patient distress when ACP is conducted by a trained facilitator. This finding can be used to persuade health professionals to refer their patients for ACP. Additional research is needed to determine if increased patientsurrogate congruence leads to patients' wishes being followed and reduces surrogate decisional conflict and distress at EOL. Future research is also needed to determine if the Respecting Choices DS-ACP intervention is equally effective with racial and ethnic groups whose reluctance v to engage in EOL discussion has been documented in the literature or if the intervention needs to be culturally adapted.
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Doctor of Philosophy (Ph.D.)
College of Nursing
Length of Campus-only Access
Doctoral Dissertation (Open Access)
Dissertations, Academic -- Nursing, Nursing -- Dissertations, Academic
Waser, Lynn, "Impact Of Cancer-specific Advance Care Planning On Anxiety, Decisional Conflict, And Surrogate Understanding Of Patient Treatment Preferences" (2012). Electronic Theses and Dissertations, 2004-2019. 2431.