Advance Care Planning and Attainment of Cancer Patients’ End-of-Life Preferences: Relatives’ Perspective

PURPOSE: The purpose of this study is to determine which element of advance care planning (ACP) - an advance directives (AD) document or an end-of-life discussion between patient and family (DwF), if any—improves the likelihood of cancer patients’ attaining their preferences regarding treatments in the last month of life and dying in the place they prefer. METHODS: First-degree relatives of deceased cancer patients, interviewed by telephone, were asked if the treatments the patients received in their last month of life and their place of death corresponded to the patients’ preferences. Nominal logistic regression analyses were conducted in search of significant association between having an AD document and/or conducting a DwF and patients’ treatment and place of death in accordance with their preferences. RESULTS: 491 deceased patients were included in the study. Their average age was 68; 52% were women. According to 32% of the relatives, the patients’ treatment in the last month of life was aligned with their preferences and 55% said the patients had died in their preferred place. Only 16.5% had an AD document, 58.5% only discussed their treatment preferences with relatives, and 25% did neither. DwF and ability to speak until last week of life were significantly related to receiving treatment consistent with patients’ preferences. Dying where the patient prefers is significantly associated with having an AD and a DwF, with an AD yielding higher odds. CONCLUSION: A multifaceted interconnection exists between the two elements of ACP in attaining cancer patients’ wishes and abetting better end of life care.