Advance care planning (ACP) in incurable cancer patients with disease progression on first line chemotherapy: a randomised trial

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This project aims to evaluate the effect of a formal advance care planning intervention (ACP) on the documentation of patient wishes, compliance with known end of life (EOL) wishes and the quality of death of patients with progressive incurable cancer on first line chemotherapy. Who is it for? You may be eligible to join this study if you are aged 18 years or above and have been diagnosed with an incurable cancer with disease progression on first line chemotherapy. Eligible patients must be able to nominate a family member or friend who is willing to participate in the study who is 18 years of age or over. Study details Patients and their family/friend/carer will be randomly (by chance) allocated to one of two groups. Participants in one group will receive standard end of life care. Participants in the other group will receive standard care plus a formal advance care planning intervention. All patients and family who request information on life expectancy will be provided with typical, best case and worst case scenarios for survival time. The intervention aims to promote discussion between patient and family and the health care team and to promote documentation of the patient’s preferences for continuing and EOL care. The intervention involves the patient plus a family member or friend meeting with a specially trained nurse to have conversations about their goals, wishes and needs for care now and in the future, as well as how these matters will be shared with their doctor and health care team. For those patients allocated to the group who receive the intervention, this program will take between half an hour to 3 hours over 1 to 3 visits to complete, depending on patient preference. Patients will be asked to complete some questionnaires at baseline, 6 weeks, and every 3 months thereafter to evaluate quality of life and satisfaction with care. The patient’s family/friend/carer will also be asked to complete some questionnaires at baseline, 6 weeks, every 3 months until the patient’s death, and then at 3 months after bereavement to evaluate their perceived quality of death and the impact of death on surviving family. The costs of care will also be assessed.