The Experience Of Advanced Cancer Patients And Their Relatives In Advance Care Planning: A Qualitative Study

Objective: This research is base on a localized advance care planning(ACP)intervention experimental research,its objective is to explore the experience of advanced cancer patients and their families in ACP,to analize the background experience and how it may affect ACP.This could provide perspective to evaluate the ACP practice in the cultural context of China’s mainland,and to provide reference for ACP promotion in China’s mainland.Methods: Interpretative phenomenology of qualitative research.Subjects: 1.Patients: over 18 years old;diagnosed malignant tumor by clinicians;participated ACP discussion;speak Mandarin or Cantonese;expression well;willing to share.2.Relatives: over 18 years old;close to the patient and responsible for caring;participated ACP discussion;speak Mandarin or Cantonese;expression well;willing to share.Sampling: Purposive sampling and maximum difference sampling.Sample size: Reached information saturation.Data collected method: Semi-structured individual interviews.Software: NVivo 12.Data analysis: Thematic analysis.Results: A total of 10 participants were include,5 of them were advanced cancer patients and 5 were relatives.Four themes were identified in this study: 1.Patients’ and their families’ perceptions of advance care planning: easier to know than to do;2.The physical and mental state of patients and their families in the communication of advance care plans: the future is difficult to plan for;3.Interpersonal interaction between patients and their families: communication gap;4.interpersonal interaction between patients,patients’ families and medical staff: communication asymmetry.Conclusion:(1)Advanced cancer Patients and their Relatives’ experience of ACP are regardful and being respected.They can usually understand and agree with ACP communication,but it is difficult to implement.Guidance and help from professionals may improve the implementation of ACP communication;(2)Patients and their relatives have different attitudes towards the disease and treatment,and both of them lack the awareness and ability to make plan;(3)Family members usually control the decision-making and medical-affairs communication rights of the patients,and the communication barriers between them are numerous,causing the major obstacles in ACP communication;(4)Current medical environment lacks supports for ACP communication,doctor-patient communication were replaced by doctor-relative communication,and the autonomy of patients is difficult to be respected and guaranteed.