PHASE 1

Facilitating discussion on treatment preferences and advance care planning in cancer patients using the vignette technique

Funding: Department of Health, Victoria

Investigating team: Dr Natasha Michael

Dr Annabel Pollard

Nikola Stepanov

Dr Odette Spruyt

A/Prof Clare O’Callaghan

A/Prof Joey Clayton

Patients do not select or reject diagnostic or therapeutic interventions in a vacuum; they choose interventions according to the clinical context in which they find themselves

Brett AS. Limitations of Listing Specific Medical Interventions in Advanced Directives. JAMA Aug 1991;226(6)825-828

COMMUNITY

ORGANISATION

Doctor

PatientDisease

29 Patients approached by Investigator and considered participation

6 Declined on follow up 23 had further discussion with researcher

5 withdrew following discussion and receiving

information on ACP

18 proceeded with interview

5: too unwell

1: did not return calls

3 Themes

• Theme A – ACP is individualised

• Theme B – ACP is dynamic and shared

• Theme C- Biopsycosocial and metaphysical informants of ACP

(RE) CONCEPTUALISE

COMMUNICATE

(RE) PLAN

CONVERSE

INTRODUCTION OF ADVANCE CARE PLANNING

REJECTION

CONTINUEDREJECTION

(RE) CONSIDER

RELINQUISH

• Extension of Phase 1Focus groups and interviews of carers

33 Patients approached by Investigator and considered participation

6 declined participation 18 agreed to participation had further discussion with

researcher

5 in individual interviews 13 in focus groups

9: too busy / unwell

2: patient non support

1: feel they cannot help

1: need time to digest situation

2:no reason given

PHASE 2

Facilitating discussion on treatment preferences and advance care planning in cancer patients using the vignette technique

Funding: Peter Mac Foundation Grant

Collaboration with Department of Cancer Experiences Research

• Primary objectiveTo test the feasibility of a cancer-specific ACP intervention to improve satisfaction with treatment decision-making and experience of care for patients with advanced cancer and their carers

Secondary Objectives1) To gather information on feasibility of the intervention in two clinical streams 2) To establish patients’, caregivers’ and professionals’ views of the acceptability of delivering or receiving the intervention3) To explore the capacity to integrate ACP discussions into the electronic medical record and identify any key barriers and facilitators to implementation of the ACP intervention4) To assess the suitability (sensitivity to change) of the i) Decision Conflict Scale, ii) Quality of Patient-Clinician Communication Scale, and iii) Pre-post ACP Intervention Visual Analogue Scale (VAS) Questionnaire, and inform the design of a phase III trial.

Study design 30 patients with stage III/IV and their carers (total 60)(English speaking, competent patients, AKPS >40)

↓ Baseline assessment and ACP information

↓ Patient and carer complete intervention

↓ Documentation integrated into e health system /

opportunity to discuss with oncologist↓

Repeat study measures 1 weeks later, qualitative interview

↓ Final study measures 4 weeks later

Outcome measures

• Patient and carer related experiences on decision making: Decision Conflict Scale, Pre-post VAS based on Phase 1, patient-physician communication scale

• Patient related characteristicsEuroqol-5D15 , FACT-G16, Modified Lyons scale

• Physician related experiencesPerceptions of clinical relevance and value of ACP (a self-report survey)

• System related outcomes Numbers of ACP's completed, capacity to integrate ACP's into the electronic medical record, capacity to keep to ACP's current

Qualitative data from patients, caregivers and professionals regarding acceptability and practicality