TY - JOUR
T1 - Current Status of Advance Care Planning and End-of-life Communication for Patients with Advanced and Metastatic Breast Cancer
AU - Sagara, Yasuaki
AU - Mori, Masanori
AU - Yamamoto, Sena
AU - Eguchi, Keiko
AU - Iwatani, Tsuguo
AU - Naito, Yoichi
AU - Kogawa, Takahiro
AU - Tanaka, Kiyo
AU - Kotani, Haruru
AU - Yasojima, Hiroyuki
AU - Ozaki, Yukinori
AU - Noguchi, Emi
AU - Miyasita, Minoru
AU - Kondo, Naoto
AU - Niikura, Naoki
AU - Toi, Masakazu
AU - Shien, Tadahiko
AU - Iwata, Hiroji
N1 - Funding Information:
We acknowledge the Japan Clinical Oncology Group, members of patient advocacy groups, and all participating physicians who made this study possible. This report was supported in part by the National Cancer Center Research and Development Fund (29‐A‐3) from the Ministry of Health, Labour, and Welfare and the Practical Research for Innovative Cancer Control (20ck0106307h0003) from the Japan Agency for Medical Research and Development, AMED. Grammar and language assistance was provided by professional editors at Editage, a division of Cactus Communications ( www.editage.com ).
Publisher Copyright:
© 2020 The Authors. The Oncologist published by Wiley Periodicals LLC on behalf of AlphaMed Press.
PY - 2021/4
Y1 - 2021/4
N2 - Background: Advance care planning (ACP) is a process that supports adults in understanding and sharing their personal values, life goals, and preferences regarding future medical care. We examined the current status of ACP and end-of-life (EOL) communication between oncologists and patients with metastatic breast cancer. Materials and Methods: We conducted a survey among 41 institutions that specialize in oncology by using an online tool in October 2019. Participants (118 physicians) from 38 institutions completed a 39-item questionnaire that measured facility type and function; physicians’ background and clinical approach, education about EOL communication, and understanding about ACP; and the current situation of ACP and EOL discussions. Results: Ninety-eight responses concerning physicians’ engagement in ACP with patients were obtained. Seventy-one (72%) answered that they had engaged in ACP. Among these, 23 (33%) physicians used a structured format to facilitate the conversation in their institutions, and only 6 (8%) settled triggers or sentinel events for the initiation of ACP. In the multivariable analysis, only the opportunity to learn communication skills was associated with physicians’ engagement with ACP (odds ratio: 2.8, 95% confidence interval: 1.1–7.0). The frequency and timing of communication about ACP and EOL care with patients substantially varied among the oncologists. Communication about patients’ life expectancy was less frequent compared with other topics. Conclusion: The opportunity to improve EOL communication skills promoted physicians’ engagement with ACP among patients with metastatic/advanced breast cancer. However, there were still substantial variabilities in the method, frequency, and timing of ACP and EOL communication among the oncologists. Implications for Practice: This study found that the opportunity to improve end-of-life (EOL) communication skills promoted physicians’ engagement in advance care planning (ACP) among patients with metastatic/advanced breast cancer. All oncologists who treat said patients are encouraged to participate in effective education programs concerning EOL communication skills. In clinical practice, there are substantial variabilities in the method, frequency, and timing of ACP and EOL communication among oncologists. As recommended in several clinical guidelines, the authors suggest a system that identifies patients who require conversations about their care goals, a structured format to facilitate the conversations, and continuous measurement for improving EOL care and treatment.
AB - Background: Advance care planning (ACP) is a process that supports adults in understanding and sharing their personal values, life goals, and preferences regarding future medical care. We examined the current status of ACP and end-of-life (EOL) communication between oncologists and patients with metastatic breast cancer. Materials and Methods: We conducted a survey among 41 institutions that specialize in oncology by using an online tool in October 2019. Participants (118 physicians) from 38 institutions completed a 39-item questionnaire that measured facility type and function; physicians’ background and clinical approach, education about EOL communication, and understanding about ACP; and the current situation of ACP and EOL discussions. Results: Ninety-eight responses concerning physicians’ engagement in ACP with patients were obtained. Seventy-one (72%) answered that they had engaged in ACP. Among these, 23 (33%) physicians used a structured format to facilitate the conversation in their institutions, and only 6 (8%) settled triggers or sentinel events for the initiation of ACP. In the multivariable analysis, only the opportunity to learn communication skills was associated with physicians’ engagement with ACP (odds ratio: 2.8, 95% confidence interval: 1.1–7.0). The frequency and timing of communication about ACP and EOL care with patients substantially varied among the oncologists. Communication about patients’ life expectancy was less frequent compared with other topics. Conclusion: The opportunity to improve EOL communication skills promoted physicians’ engagement with ACP among patients with metastatic/advanced breast cancer. However, there were still substantial variabilities in the method, frequency, and timing of ACP and EOL communication among the oncologists. Implications for Practice: This study found that the opportunity to improve end-of-life (EOL) communication skills promoted physicians’ engagement in advance care planning (ACP) among patients with metastatic/advanced breast cancer. All oncologists who treat said patients are encouraged to participate in effective education programs concerning EOL communication skills. In clinical practice, there are substantial variabilities in the method, frequency, and timing of ACP and EOL communication among oncologists. As recommended in several clinical guidelines, the authors suggest a system that identifies patients who require conversations about their care goals, a structured format to facilitate the conversations, and continuous measurement for improving EOL care and treatment.
KW - Advance care planning
KW - Communication
KW - End-of-life discussion
KW - Metastatic breast cancer
KW - Patient-centered care
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U2 - 10.1002/onco.13640
DO - 10.1002/onco.13640
M3 - Article
C2 - 33321004
AN - SCOPUS:85099027370
VL - 26
SP - e686-e693
JO - Oncologist
JF - Oncologist
SN - 1083-7159
IS - 4
ER -