Advance care planning and goals of care discussion: the perspectives of Brazilian oncologists
Abstract Background Advance care planning (ACP) and goals of care discussions are important instruments that enable respect for patient autonomy, especially in patients with a life-threatening disease, such as cancer. Despite their well-established benefits, ACP and goals of care discussions are sti...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12904-022-01052-w |
| _version_ | 1828111582664589312 |
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| author | Laiane Moraes Dias Mirella Rebello Bezerra Williams Fernandes Barra Ana Emília Vita Carvalho Luísa Castro Francisca Rego |
| author_facet | Laiane Moraes Dias Mirella Rebello Bezerra Williams Fernandes Barra Ana Emília Vita Carvalho Luísa Castro Francisca Rego |
| author_sort | Laiane Moraes Dias |
| collection | DOAJ |
| description | Abstract Background Advance care planning (ACP) and goals of care discussions are important instruments that enable respect for patient autonomy, especially in patients with a life-threatening disease, such as cancer. Despite their well-established benefits, ACP and goals of care discussions are still not frequently performed in clinical oncology practice. Understanding the barriers to this topic is the first step toward developing future interventions that are more likely to improve professional practice and patient satisfaction with care. Aim To explore Brazilian oncologists’ barriers to discuss goals of care and advance care planning. Methods A cross-sectional study was developed to identify Brazilian oncologists’ barriers to discussing goals of care and ACP. The Decide-Oncology questionnaire was used to identify the importance of these barriers according to oncologists’ perceptions. Participants were asked to rank the importance of various barriers to discussing goals of care, ranging from 1 (extremely unimportant) to 7 (extremely important). A quantitative analysis using descriptive statistics was used, including median and interquartile intervals and a qualitative analysis based on Bardin content analysis of the two open questions. Results Sixty-six oncologists participated in this study. Most of them perceived the patient and family’s related barriers as the most important, such as patients’ difficulty in understanding their diagnosis and accepting their prognosis. Physician and external related factors, such as lack of training and lack of time for this conversation, were also described as important barriers. Participants with formal training regarding goals of care communication and with experience in palliative care perceived the lack of patients’ advanced directives as a significant barrier and manifested more willingness to participate in decision-making about goals of care. The lack of access and of support for referral to palliative care was also considered a significant barrier for ACP and goals of care discussion. Conclusion The identification of barriers that limit the discussion of ACP and early palliative care referrals can certainly help to prioritise the next steps for future studies aimed at improving ACP and helping clinicians to better support patients through shared decision-making based on the patient’s values and experiences. |
| first_indexed | 2024-04-11T11:38:03Z |
| format | Article |
| id | doaj.art-977950167ce24d649d8de9f0acbaa04b |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-04-11T11:38:03Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-977950167ce24d649d8de9f0acbaa04b2022-12-22T04:25:55ZengBMCBMC Palliative Care1472-684X2022-09-012111910.1186/s12904-022-01052-wAdvance care planning and goals of care discussion: the perspectives of Brazilian oncologistsLaiane Moraes Dias0Mirella Rebello Bezerra1Williams Fernandes Barra2Ana Emília Vita Carvalho3Luísa Castro4Francisca Rego5Faculty of Medicine of the University of PortoFaculty of Medicine of the University of PortoJoão de Barros Barreto University Hospital, Federal University of Pará, Dom Romualdo de SeixasCESUPA, Pará University CenterFaculty of Medicine of the University of PortoFaculty of Medicine of the University of PortoAbstract Background Advance care planning (ACP) and goals of care discussions are important instruments that enable respect for patient autonomy, especially in patients with a life-threatening disease, such as cancer. Despite their well-established benefits, ACP and goals of care discussions are still not frequently performed in clinical oncology practice. Understanding the barriers to this topic is the first step toward developing future interventions that are more likely to improve professional practice and patient satisfaction with care. Aim To explore Brazilian oncologists’ barriers to discuss goals of care and advance care planning. Methods A cross-sectional study was developed to identify Brazilian oncologists’ barriers to discussing goals of care and ACP. The Decide-Oncology questionnaire was used to identify the importance of these barriers according to oncologists’ perceptions. Participants were asked to rank the importance of various barriers to discussing goals of care, ranging from 1 (extremely unimportant) to 7 (extremely important). A quantitative analysis using descriptive statistics was used, including median and interquartile intervals and a qualitative analysis based on Bardin content analysis of the two open questions. Results Sixty-six oncologists participated in this study. Most of them perceived the patient and family’s related barriers as the most important, such as patients’ difficulty in understanding their diagnosis and accepting their prognosis. Physician and external related factors, such as lack of training and lack of time for this conversation, were also described as important barriers. Participants with formal training regarding goals of care communication and with experience in palliative care perceived the lack of patients’ advanced directives as a significant barrier and manifested more willingness to participate in decision-making about goals of care. The lack of access and of support for referral to palliative care was also considered a significant barrier for ACP and goals of care discussion. Conclusion The identification of barriers that limit the discussion of ACP and early palliative care referrals can certainly help to prioritise the next steps for future studies aimed at improving ACP and helping clinicians to better support patients through shared decision-making based on the patient’s values and experiences.https://doi.org/10.1186/s12904-022-01052-wPersonal autonomyOncologyAdvance care planning |
| spellingShingle | Laiane Moraes Dias Mirella Rebello Bezerra Williams Fernandes Barra Ana Emília Vita Carvalho Luísa Castro Francisca Rego Advance care planning and goals of care discussion: the perspectives of Brazilian oncologists BMC Palliative Care Personal autonomy Oncology Advance care planning |
| title | Advance care planning and goals of care discussion: the perspectives of Brazilian oncologists |
| title_full | Advance care planning and goals of care discussion: the perspectives of Brazilian oncologists |
| title_fullStr | Advance care planning and goals of care discussion: the perspectives of Brazilian oncologists |
| title_full_unstemmed | Advance care planning and goals of care discussion: the perspectives of Brazilian oncologists |
| title_short | Advance care planning and goals of care discussion: the perspectives of Brazilian oncologists |
| title_sort | advance care planning and goals of care discussion the perspectives of brazilian oncologists |
| topic | Personal autonomy Oncology Advance care planning |
| url | https://doi.org/10.1186/s12904-022-01052-w |
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