Family-Integrated Advance Care Planning for Cancer Patients: A Mixed-Methods Feasibility Study.

Abstract

Advance care planning programs which focus on facilitating conversations among families are scant. We developed a family-integrated Serious Illness Conversation Guide (SICG-Fam). This study aims to examine the ability and acceptability of the SICG-Fam for advanced cancer patients, family members and physicians in Japan. Trained physicians provided their patients and family members with serious illness conversations using the SICG-Fam. Data regarding ability and acceptability were collected through questionnaires and semi-structured interviews with patients, family members and physicians. Descriptive statistics and thematic analyses were conducted for data analysis. From February to May 2023, 10 physicians and 22 dyads comprising 22 patients and 24 family members participated. Physicians had a median of 19 years' experience. Each item in the SICG-Fam was delivered by physicians in 18-22 of all the 22 conversations. Patients and family members, except for one family member, judged the conversation as being helpful to discuss their respective views on patients' wishes. Two patients and four family members evaluated the conversation as distressing. Family context, including family relationships, and how physicians engage with them, including supportive attitudes and encouraging patients and family members to express their views, affected the perceived helpfulness of the conversation. The SICG-Fam was delivered by physicians and accepted by patients and family members. However, how physicians consider the family perception of the conversation may mitigate potential patient and family member distress. Future studies should focus on further refining the intervention to address the identified challenges and rigorously investigate the effectiveness of this approach.