How does advance care planning influence patient outcomes in cancer treatment?
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Advance Care Planning and Patient Outcomes in Cancer Treatment
Advance Care Planning and Reduced Acute Care Use
Advance care planning (ACP) is linked to a reduction in hospital readmissions, emergency department visits, and overall acute care use among cancer patients. Studies show that patients with documented ACP are less likely to be readmitted to the hospital or visit the emergency department within 30 days of discharge, independent of hospice utilization . Community health worker-led ACP interventions further reduce acute care use, increase palliative and hospice care utilization, and improve mental and emotional health outcomes for patients with advanced cancer .
Influence on End-of-Life Care and Treatment Intensity
ACP is associated with less aggressive end-of-life care, including lower odds of receiving chemotherapy, intensive care, and hospital admissions near the end of life. Patients with ACP are also more likely to have do-not-resuscitate orders and to avoid hospital deaths . However, some studies note that while ACP increases documentation and palliative care use, it does not always lead to significant changes in the quality of life or ensure that end-of-life care aligns perfectly with patient preferences, especially in cultures where family decisions may override patient wishes 347.
Psychological and Emotional Outcomes
ACP interventions can improve psychological well-being by reducing anxiety and depressive symptoms in terminally ill cancer patients, even if they do not significantly impact overall quality of life or the concordance between preferred and received life-sustaining treatments 47. Emotional support during ACP and end-of-life conversations is important for helping patients cope with their prognosis and make informed decisions .
Patient Awareness, Decision-Making, and Communication
ACP enhances patients’ awareness of their prognosis and supports shared decision-making between patients, families, and healthcare providers. Effective ACP involves not just documentation but also meaningful communication, which has a greater impact on reducing hospital admissions and ensuring care aligns with patient values 25910. Early and ongoing conversations about care preferences are critical for achieving patient-centered outcomes 69.
Mechanisms and Models of ACP Impact
The effectiveness of ACP is driven by increasing patient knowledge, strengthening motivation, building competence for end-of-life discussions, and fostering trustful relationships for shared decision-making. These mechanisms help patients articulate their values and make informed choices about their care . However, the use of structured conceptual models in ACP interventions is still uncommon, and more research is needed to adapt these models to diverse cultural and educational backgrounds .
Conclusion
Advance care planning in cancer treatment is associated with reduced acute care use, less aggressive end-of-life interventions, improved psychological outcomes, and enhanced patient-provider communication. While ACP does not always guarantee that care will match patient preferences or improve quality of life, it plays a vital role in supporting informed, value-concordant decision-making and emotional well-being for patients with cancer 1234+6 MORE.
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Most relevant research papers on this topic
Advance care planning and hospital outcomes in solid tumour oncology inpatients
Advance care planning (ACP) is associated with decreased 30-day readmissions and emergency department visits in patients with solid tumor oncology, independent of hospice utilization.
Don’t Throw the Baby Out with the Bathwater: Meta-Analysis of Advance Care Planning and End-of-life Cancer Care
Advance care planning (ACP) is associated with reduced aggressive cancer care outcomes, with communication components of ACP having a greater impact on hospital admissions.
Effect of a Community Health Worker Intervention on Acute Care Use, Advance Care Planning, and Patient-Reported Outcomes Among Adults With Advanced Stages of Cancer: A Randomized Clinical Trial.
A CHW-led intervention in cancer care reduced acute care use and improved patient-reported outcomes compared to usual care in advanced-stage cancer patients.
Impact of advance care planning and end-of-life conversations on patients with cancer: An integrative review of literature.
Advance care planning and end-of-life conversations significantly improve cancer patients' awareness, decision-making, and emotional support during end-of-life care decisions.
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