title: Understanding how cancer patients actualise, relinquish, and reject advance care planning: implications for practice.
abstract: OBJECTIVE
  Although advance care planning (ACP) is recognised as integral to quality cancer care, it remains poorly integrated in many settings. Given cancer patients' unpredictable disease trajectories and equivocal treatment options, a disease-specific ACP model may be necessary. This study examines how Australian cancer patients consider ACP. Responses will inform the development of an Australian Cancer Centre's ACP programme.
  
  
  METHODS
  A constructivist research approach with grounded theory design was applied. Eighteen adults from lung and gastro-intestinal tumour streams participated. Participants first described their initial understanding of ACP, received ACP information, and finally completed a semi-structured interview assisted by the vignette technique. Qualitative inter-rater reliability was integrated.
  
  
  RESULTS
  Participants initially had scant knowledge of ACP. On obtaining further information, their responses indicated that: For cancer patients, ACP is an individualised, dynamic, and shared process characterised by myriad variations in choices to actualise, relinquish, and/or reject its individual components (medical enduring power of attorney, statement of choices, refusal of treatment certificate, and advanced directive). Actualisation of each component involves considering, possibly conversing about, planning, and communicating a decision, usually iteratively. Reactions can change over time and are informed by values, memories, personalities, health perceptions, appreciation of prognoses, and trust or doubts in their substitute decision makers.
  
  
  CONCLUSIONS
  Findings endorse the value of routinely, though sensitively, discussing ACP with cancer patients at various time points across their disease trajectory. Nonetheless, ACP may also be relinquished or rejected and ongoing offers for ACP in some patients may be offensive to their value system.
authors.affiliation: Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, Peter Mac, Locked Bag 1, A'Beckett Street, Victoria, VIC, 8006, Australia. natasha.michael@petermac.org
authors.forename: Natasha
authors.initials: N
authors.lastname: Michael
authors.forename: Clare
authors.initials: C
authors.lastname: O'Callaghan
authors.forename: Josephine
authors.initials: J
authors.lastname: Clayton
authors.forename: Annabel
authors.initials: A
authors.lastname: Pollard
authors.forename: Nikola
authors.initials: N
authors.lastname: Stepanov
authors.forename: Odette
authors.initials: O
authors.lastname: Spruyt
authors.forename: Michael
authors.initials: M
authors.lastname: Michael
authors.forename: David
authors.initials: D
authors.lastname: Ball
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D016223:Advance Directives; D000368:Aged; D001315:Australia; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009369:Neoplasms / Q000523:psychology*; D015203:Reproducibility of Results; D035502:Trust