title: 'We have to discuss it': cancer patients' advance care planning impressions following educational information about cardiopulmonary resuscitation.
abstract: OBJECTIVE
  Most cancer patients desire information about care options at the end of life, including cardiopulmonary resuscitation (CPR). Communicating such care options can be challenging and is part of advance care planning (ACP). Our prior studies with video educational media produced data on patients' categoric preferences (yes/no/unsure) for CPR; however, the thematic underpinnings of these educated preferences in patients treated for advanced cancer aren't well known.
  
  
  METHODS
  Qualitative thematic content analysis of participants' responses in a randomized trial of an educational video (V) or narrative (N) about CPR in patients with advanced gastrointestinal cancers. Responses were independently coded and categorized for thematic content by two reviewers.
  
  
  RESULTS
  Of 54 study participants, 26 total (41% of V arm, 56% of N arm) articulated questions, comments, or both. Reviewer analyses demonstrated thematic consensus and resulted in seven distinct themes listed in decreasing order of prevalence: (a) ACP should be started early; (b) educational information about CPR affirmed participants' existing beliefs/knowledge/values about advanced illness; (c) participants were apprehensive about ACP but wanted to discuss it; (d) gaps in knowledge about ACP emerged; (e) CPR information was helpful/acceptable; (f) physicians should be involved in ACP; and (g) medical questions about critical illness arose.
  
  
  CONCLUSIONS
  Findings identified that while sometimes difficult to discuss, advance care planning is desired, deemed helpful, and ideally begun early by clinicians, and that video education is an appropriate and affirming initiator of discussions. These themes are incorporated into our ongoing research on cancer patient-specific values and education about care options.
authors.affiliation: Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Epstein
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Shuk
authors.affiliation: Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: O'Reilly
authors.affiliation: Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Gary
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Volandes
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D001294:Attitude to Health; D016887:Cardiopulmonary Resuscitation / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010353:Patient Education as Topic; D010358:Patient Participation / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*