Unraveling patients’ readiness in advance care planning conversations: a qualitative study as part of the ACTION Study

M. Zwakman, M. M. Milota, A. van der Heide, L. J. Jabbarian, I. J. Korfage, J. A.C. Rietjens, J. J.M. van Delden, M. C. Kars*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

31 Citations (Scopus)
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Purpose: Patients’ readiness for advance care planning (ACP) is often considered a prerequisite for starting ACP conversations. Healthcare professionals’ uncertainty about patients’ readiness hampers the uptake of ACP in clinical practice. This study aims To determine how patients’ readiness is expressed and develops throughout an ACP conversation. Methods: A qualitative sub-study into the ACTION ACP conversations collected as part of the international Phase III multicenter cluster-randomized clinical trial. A purposeful sample was taken of ACP conversations of patients with advanced lung or colorectal cancer who participated in the ACTION study between May 2015 and December 2018 (n = 15). A content analysis of the ACP conversations was conducted. Results: All patients (n = 15) expressed both signs of not being ready and of being ready. Signs of being ready included anticipating possible future scenarios or demonstrating an understanding of one’s disease. Signs of not being ready included limiting one’s perspective to the here and now or indicating a preference not to talk about an ACP topic. Signs of not being ready occurred more often when future-oriented topics were discussed. Despite showing signs of not being ready, patients were able to continue the conversation when a new topic was introduced. Conclusion: Healthcare professionals should be aware that patients do not have to be ready for all ACP topics to be able to participate in an ACP conversation. They should be sensitive to signs of not being ready and develop the ability to adapt the conversation accordingly.

Original languageEnglish
Pages (from-to)2917-2929
Number of pages13
JournalSupportive Care in Cancer
Issue number6
Early online date1 Oct 2020
Publication statusPublished - Jun 2021

Bibliographical note

Funding Information:
The ACTION project is funded by the 7th Framework Programme for Research and Technological Development (FP7) (Proposal No: 602541-2). The funders had no involvement in any aspect of the study. Acknowledgments Code availability

Publisher Copyright:
© 2020, The Author(s).


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