title: A mixed method feasibility study of a patient- and family-centred advance care planning intervention for cancer patients.
abstract: BACKGROUND
  Advance care planning (ACP) is a process whereby values and goals are sensitively explored and documented to uphold patients' wishes should they become incompetent to make decisions in the future. Evidenced-based, effective approaches are needed. This study sought to assess the feasibility and acceptability of an ACP intervention informed by phase 1 findings and assessed the suitability of measures for a phase 3 trial.
  
  
  METHODS
  Prospective, longitudinal, mixed methods study with convenience sampling. A skilled facilitator conducted an ACP intervention with stage III/IV cancer patients and invited caregivers. It incorporated the vignette technique and optional completion/integration of ACP documents into electronic medical records (EMR). Quantitative and qualitative data were collected concurrently, analysed separately, and the two sets of findings converged.
  
  
  RESULTS
  Forty-seven percent consent rate with 30 patients and 26 caregivers completing the intervention. Ninety percent of patient participants had not or probably not written future care plans. Compliance with assessments was high and missing responses to items low. Small- to medium-sized changes were observed on a number of patients and caregiver completed measures, but confidence intervals were typically wide and most included zero. An increase in distress was reported; however, all believed the intervention should be made available. Eleven documents from nine patients were incorporated into EMR. ACP may not be furthered because of intervention inadequacies, busy lives, and reluctance to plan ahead.
  
  
  CONCLUSIONS
  In this phase 2 study we demonstrated feasibility of recruitment and acceptability of the ACP intervention and most outcome measures. However, patient/family preferences about when and whether to document ACP components need to be respected. Thus flexibility to accommodate variability in intervention delivery, tailored to individual patient/family preferences, may be required for phase 3 research.
authors.affiliation: Palliative Care Service, Cabrini Health, 646 High Street, Prahran, Victoria, 3181, Australia. NMichael@cabrini.com.au.|Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, 3800, Australia. NMichael@cabrini.com.au.
authors.forename: Natasha
authors.initials: N
authors.lastname: Michael
authors.affiliation: Palliative Care Service, Cabrini Health, 646 High Street, Prahran, Victoria, 3181, Australia. COCallaghan@cabrini.com.au.|Caritas Christi Hospice, St Vincent's Hospital, 104 Studley Park Rd Kew, Victoria, 3101, Australia. COCallaghan@cabrini.com.au.|Department of Medicine, St Vincent's Hospital, Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia. COCallaghan@cabrini.com.au.|Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, VIC, 3002, Australia. COCallaghan@cabrini.com.au.
authors.forename: Clare
authors.initials: C
authors.lastname: O'Callaghan
authors.affiliation: Palliative Care Service, Cabrini Health, 646 High Street, Prahran, Victoria, 3181, Australia. abaird@cabrini.com.au.
authors.forename: Angela
authors.initials: A
authors.lastname: Baird
authors.affiliation: Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, VIC, 3002, Australia. Karla.Gough@petermac.org.
authors.forename: Karla
authors.initials: K
authors.lastname: Gough
authors.affiliation: Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, VIC, 3002, Australia. meinir.krishnasamy@petermac.org.|Department of Nursing, University of Melbourne, Carlton, VIC, 3053, Australia. meinir.krishnasamy@petermac.org.
authors.forename: Mei
authors.initials: M
authors.lastname: Krishnasamy
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, 3800, Australia. njhis3@student.monash.edu.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Hiscock
authors.affiliation: HammondCare Palliative and Supportive Care Service, Greenwich Hospital, 97-115 River Road, Greenwich, NSW, 2065, Australia. josephine.clayton@sydney.edu.au.|Sydney Medical School, University of Sydney, New South Wales, 2006, Australia. josephine.clayton@sydney.edu.au.
authors.forename: Josephine
authors.initials: J
authors.lastname: Clayton
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration*; D000368:Aged; D017028:Caregivers / Q000523:psychology; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009369:Neoplasms / Q000523:psychology*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011446:Prospective Studies; D012107:Research Design; D013727:Terminal Care / Q000458:organization & administration*