title: Advance care planning discussions in advanced cancer: analysis of dialogues between patients and care planning mediators.
abstract: OBJECTIVE
  Advance care planning (ACP) provides patients with an opportunity to consider, discuss, and plan their future care with health professionals. Numerous policy documents recommend that ACP should be available to all with life-limiting illness.
  
  
  METHODS
  Forty patients with recurrent progressive cancer completed one or more ACP discussions with a trained planning mediator using a standardized topic guide. Fifty-two interviews were transcribed verbatim and analyzed for qualitative thematic content.
  
  
  RESULTS
  Most patients had not spoken extensively to health professionals or close persons about the future. Their concerns related to experiencing distressing symptoms or worrying how family members would cope. Some patients wished for more accurate information and were unaware of their options for care. Many felt it was doctors' responsibility to initiate such discussions, but perceived that their doctors were reluctant to do so. However, some patients felt that the time was not yet right for these conversations.
  
  
  CONCLUSIONS
  This article reports on the recorded content of ACP discussions. The extent to which patients want to engage in ACP is variable, and support and training are needed for health professionals to initiate such discussions. Our findings do not fully support the current United Kingdom policy of introducing ACP early in life-threatening disease.
authors.affiliation: Marie Curie Palliative Care Research Unit, Research Department of Mental Health Sciences, UCL Medical School, University College London, Royal Free Campus, London, UK.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Barnes
authors.forename: Cate A
authors.initials: CA
authors.lastname: Barlow
authors.forename: Jane
authors.initials: J
authors.lastname: Harrington
authors.forename: Karon
authors.initials: K
authors.lastname: Ornadel
authors.forename: Adrian
authors.initials: A
authors.lastname: Tookman
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D001293:Attitude to Death; D003142:Communication; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D057240:Patient Preference; D011369:Professional-Patient Relations; D036301:Qualitative Research; D013727:Terminal Care / Q000523:psychology*; D006113:United Kingdom