Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

A qualitative study of factors influencing Advanced Care Planning in oncology (#330)

Candice Donnelly 1 , Anna Janssen 1 , Kavisha Shah 1 , Paul Harnett 1 2 3 , Sally Greenaway 4 , Jane Phillips 5 , David Currow 6 , Catrina Bines 2 3 , Likhitha Sudini 1 7 , Rhiannon Mellor 2 3 , Jared Millican 4 , Tim Shaw 1
  1. Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
  2. Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead
  3. Sydney West Cancer Network, Western Sydney & Nepean Blue Mountains Local Health Districts, NSW, Australia
  4. Department of Supportive and Palliative Care, Western Sydney Local Health District, NSW, Australia
  5. School of Nursing, Faculty of Health, Queensland University of Technology, NSW, Australia
  6. Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
  7. Westmead Hospital, Western Sydney Local Health District, NSW, Australia

Background: Advance Care Planning (ACP) is a patient-centred process that enables individuals to consider their goals and priorities, and make plans with their healthcare team for future care needs. Oncology clinicians care for a significant number of critically ill patients and are central to facilitating and documenting ACP conversations. The benefits of ACP in oncology are widely supported by Australian and international guidelines. However, reported rates of clinician involvement in ACP are low and documentation of ACPs remain suboptimal.

Aims: The aim of the study is to (1) explore oncology clinicians’ ACP knowledge, decision making and routine practice, and factors that influence the ACP process (2) enhance understanding of the supports needed for oncology clinicians to increase ACP completion.

Methods: Participants were purposefully sampled for participation in semi-structured interviews conducted between November 2021-March 2022. Interviews were recorded and transcribed, and data was analysed by coding transcripts to the Theoretical Domains Framework (TDF) in a deductive thematic analysis. The data was then analysed utilising an inductive approach to thematically generate explanatory sub-themes within identified domains.

Results: Participants (n=11) included medical/radiation oncology consultants (54.5%) and oncology advance trainees (45.5%). Interview length ranged from 17.5-35.5 minutes. Codes were mapped to all 14 TDF domains. Delivery of ACP was linked to knowledge, confidence, attitudes and experience, as well as factors related to environmental context and resources. All participants associated ACP with best-practice but noted barriers to delivery include; limited legal literacy, a lack of formal training, inter-disciplinary communication, workload, professional experience and confidence, EMR usability, and patient characteristics (i.e. psychological state, health literacy). 

Conclusion: The socio-cultural environment surrounding ACP is extremely complex, and associated with multiple co-dependent factors. Future quality improvement programs should be designed accordingly to ensure ACP interventions are appropriately targeted to the implementation context.