title: Talking about end-of-life preferences with advanced cancer patients: factors influencing feasibility.
abstract: BACKGROUND
  The End-of-Life Preferences Interview (ELPI) was developed with the purpose of supporting physicians in communicating with advanced cancer patients.
  
  
  OBJECTIVE
  This study aimed to evaluate ELPI feasibility and compare home care/hospice (HC-H) vs. outpatient (OU) care settings.
  
  
  METHODS
  Twenty-eight physicians were trained in the use of the ELPI and were asked to apply the new instrument in their daily clinical practice for two months. ELPI feasibility was evaluated through three indices: the percentage of eligible patients, the percentage of patients to whom the ELPI was proposed, and the percentage of completed interviews.
  
  
  RESULTS
  The 23 physicians participating in the data collection screened 633 patients, and 156 of them (25%, 95% confidence interval 21%-28%) were judged to be eligible. Eligibility in HC-H was lower than that in the OU setting (18% vs. 46%; P<0.0001), whereas the differences were reduced when looking at patients to whom the ELPI was proposed (12% vs. 20%; P=0.017) and who completed the ELPI (8% vs. 18%; P<0.001). The percentage of eligible patients refusing the interview was very low in the entire sample (1.9%).
  
  
  CONCLUSIONS
  Results indicate that discussing end-of-life preferences in an earlier disease phase, such as in the OU setting, could be preferable but that its accomplishment in this setting may be more difficult, mainly as a result of organizational reasons. This observation could indicate that the system is not yet ready to offer patients such an opportunity and although communication on these sensitive issues cannot be reduced to a procedure, the ELPI can become a useful tool to help physicians in accomplishing this difficult task.
authors.affiliation: Clinical Psychology Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy. claudia.borreani@istitutotumori.mi.it
authors.forename: Claudia
authors.initials: C
authors.lastname: Borreani
authors.forename: Cinzia
authors.initials: C
authors.lastname: Brunelli
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bianchi
authors.forename: Laura
authors.initials: L
authors.lastname: Piva
authors.forename: Cecilia
authors.initials: C
authors.lastname: Moro
authors.forename: Guido
authors.initials: G
authors.lastname: Miccinesi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D037001:Directive Counseling / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000451:nursing*; D010353:Patient Education as Topic / Q000379:methods* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000706:statistics & numerical data; D019452:Terminally Ill / Q000706:statistics & numerical data