Advance care planning in patients with cancer referred to a phase I clinical trials program: the MD Anderson Cancer Center experience.
OBJECTIVE
Patients with advanced malignancies referred for early clinical trials have a short life expectancy. We designed this survey to ascertain the status of advance care planning in this population.


METHODS
Patients who were seen in a phase I clinic were asked to anonymously complete an investigator-designed survey.


RESULTS
Of 435 individuals approached, 215 (49%) returned completed or partially completed surveys, whereas many others stated that they wanted to avoid the topic, because they had come to the phase I clinic for cancer therapy. Most patients (n = 149; 69%) were still hopeful about their future. Approximately 42% of patients (n = 90) reported having a living will, 46% had a medical power of attorney (n = 98), and 19% had a do-not-resuscitate (DNR) order (n = 40). Approximately 20% of participants (n = 43) had not discussed advance care planning. Fifty-nine percent of patients wanted to discuss advance care planning with their physician. Having a DNR order in place was significantly more common in individuals who had a living will and/or a medical power of attorney.


CONCLUSIONS
Although most patients referred to a phase I clinic remained optimistic, many had discussed a living will, medical power of attorney, and/or DNR order with their physician, family, and/or attorney. However, a significant minority had not addressed this issue with anyone, and many refused to take a survey on the topic. More than half of the patients wanted to discuss these matters with their physician. These observations suggest that extra effort to address advance care planning is needed for these patients.
Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. siqingfu@mdanderson.org
Siqing
S
Fu
F Diane
FD
Barber
Aung
A
Naing
Jennifer
J
Wheler
David
D
Hong
Gerald
G
Falchook
Sarina
S
Piha-Paul
Apostolia
A
Tsimberidou
Adrienne
A
Howard
Razelle
R
Kurzrock
D032722:Advance Care Planning; D002986:Clinical Trials as Topic; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy