Family-Centered Advance Care Planning in Patients With Breast Cancer: A Randomized Controlled Trial in China

Abstract

Objective: To evaluate the feasibility, acceptability, and effects of family-centered advance care planning (ACP) in patients with breast cancer. Methods: In this randomized controlled trial, 80 breast cancer patients were assigned to either a family-centered ACP group or a standard care group. Outcomes were measured at baseline and one month after the intervention using the Advance Care Planning Acceptance Questionnaire (ACPQ), Templer Death Anxiety Scale (T-DAS), Functional Assessment of Cancer Therapy – Breast (FACT-B), and a self-designed questionnaire. Results: Compared to controls, the intervention group showed higher ACP acceptance and improved quality of life (excluding physical well-being and additional concerns), along with lower death anxiety and reduced preference for life-sustaining treatments and aggressive end-of-life care. Conclusion: Family-centered ACP is feasible and acceptable for breast cancer patients. It enhances ACP engagement, improves quality of life, and reduces death anxiety. This study was prospectively registered in a publicly accessible clinical trial registry.

Keywords

advance care planning advance directive palliative care family intervention breast cancer China

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References

Abdo

Ortman

Rodriguez

Tillman

Riordan

E. O.

Seydel

(2023). Quality of life issues following breast cancer treatment. Surgical Clinics of North America, 103(1), 155–167. https://doi.org/10.1016/j.suc.2022.08.014

Arch

J. J.

Bright

E. E.

Finkelstein

L. B.

Fink

R. M.

Mitchell

J. L.

Andorsky

D. J.

Kutner

J. S.

(2023). Anxiety and depression in metastatic cancer: A critical review of negative impacts on advance care planning and end-of-life decision making with practical recommendations. JCO Oncology Practice, 19(12), 1097–1108. https://doi.org/10.1200/OP.23.00287

Brinkman-Stoppelenburg

Rietjens

J. A.

van der Heide

(2014). The effects of advance care planning on end-of-life care: A systematic review. Palliative Medicine, 28(8), 1000–1025. https://doi.org/10.1177/0269216314526272

Jin

Fan

Cheng

A. S. K.

P. H. F.

Xia

Liu

(2022). Unmet needs of 1210 Chinese breast cancer survivors and associated factors: A multicentre cross-sectional study. BMC Cancer, 22(1), 135. https://doi.org/10.1186/s12885-022-09224-w

Canny

Mason

Boyd

(2023). Public perceptions of advance care planning (ACP) from an international perspective: A scoping review. BMC Palliative Care, 22(1), 107. https://doi.org/10.1186/s12904-023-01230-4

Cella

D. F.

Tulsky

D. S.

Gray

Sarafian

Linn

Bonomi

Silberman

Yellen

S. B.

Winicour

Brannon

(1993). The functional assessment of cancer therapy scale: Development and validation of the general measure. Journal of Clinical Oncology, 11(3), 570–579. https://doi.org/10.1200/JCO.1993.11.3.570

Cheng

H. W. B.

(2018). Advance care planning in Chinese seniors: Cultural perspectives. Journal of Palliative Care, 33(4), 242–246. https://doi.org/10.1177/0825859718763644

Da Rocha Rodrigues

M. G.

Pautex

Shaha

(2016). Revie plus: The influence of a life review intervention including a positive, patient-centered approach towards enhancing the personal dignity of patients with advanced cancer: A study protocol for a feasibility study using a mixed-methods investigation. Pilot and Feasibility Studies, 2, 63. https://doi.org/10.1186/s40814-016-0101-z

Ginsburg

Bray

Coleman

M. P.

Vanderpuye

Eniu

Kotha

S. R.

Sarker

Huong

T. T.

Allemani

Dvaladze

Gralow

Yeates

Taylor

Oomman

Krishnan

Sullivan

Kombe

Blas

M. M.

ParhamConteh

G. L.

(2017). The global burden of women's cancers: A grand challenge in global health. The Lancet, 389(10071), 847–860. https://doi.org/10.1016/S0140-6736(16)31392-7

10.

Hendry

Pottle

Johnstone

Poolman

Hiscock

(2022). The intricacy of interactions: Qualitative exploration of preferences and perceptions of advance care planning among healthcare professionals, patients and those close to them. Palliative Care and Social Practice, 16, Article 26323524221139879. https://doi.org/10.1177/26323524221139879

11.

Hines

S. C.

Glover

J. J.

Babrow

A. S.

Holley

J. L.

Badzek

L. A.

Moss

A. H.

(2001). Improving advance care planning by accommodating family preferences. Journal of Palliative Medicine, 4(4), 481–489. https://doi.org/10.1089/109662101753381629

12.

Hou

X. T.

Y. H.

Yang

Guo

R. X.

Wang

Wen

L. H.

Zhang

Y. R.

Sun

H. Y.

(2021). The knowledge and attitude towards advance care planning among Chinese patients with advanced cancer. Journal of Cancer Education, 36(3), 603–610. https://doi.org/10.1007/s13187-019-01670-8

13.

Jia

Stokes

S. C.

Pan

S. Y.

Leiter

R. E.

Lum

H. D.

Pan

C. X.

(2021). Heart to heart cards: A novel, culturally tailored, community-based advance care planning tool for Chinese Americans. American Journal of Hospice & Palliative Care, 38(6), 650–657. https://doi.org/10.1177/1049909121989986

14.

Park

E. J.

Choi

J. Y.

(2021). The acceptability and effect of a communication-based advance care planning program for older adults. Journal of Hospice and Palliative Nursing, 23(4), 375–385. https://doi.org/10.1097/NJH.0000000000000762

15.

Kasymjanova

Tran

A. T.

Cohen

Pepe

Sakr

Small

Agulnik

J. S.

Jagoe

R. T.

(2018). The use of a standardized Chinese herbal formula in patients with advanced lung cancer: A feasibility study. Journal of Integrative Medicine, 16(6), 390–395. https://doi.org/10.1016/j.joim.2018.09.001

16.

Lei

Zheng

Zhang

Wang

Chen

Sun

Zeng

Zhou

Wei

(2021). Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020. Cancer Communications, 41(11), 1183–1194. https://doi.org/10.1002/cac2.12207

17.

Lin

T. T.

S. N.

Zhao

L. Y.

(2021). Pre-planned medical care schemes for elderly patients with end-stage chronic respiratory diseases and their family members. Modern Clinical Nursing, 20(01), 20–25. https://doi.org/10.3969/j.issn.1671-8283.2021.01.004

18.

Lyon

M. E.

Jacobs

Briggs

Cheng

Y. I.

Wang

(2013). Family-centered advance care planning for teens with cancer. JAMA Pediatrics, 167(5), 460–467. https://doi.org/10.1001/jamapediatrics.2013.943

19.

Masoudi-Khoram

Abdolmaleki

(2022). Role of non-coding RNAs in response of breast cancer to radiation therapy. Molecular Biology Reports, 49(6), 5199–5208. https://doi.org/10.1007/s11033-022-07234-2

20.

Michael

O'Callaghan

Baird

Hiscock

Clayton

(2014). Cancer caregivers advocate a patient- and family-centered approach to advance care planning. Journal of Pain and Symptom Management, 47(6), 1064–1077. https://doi.org/10.1016/j.jpainsymman.2013.07.009

21.

Neel

Rydall

Hales

Rodin

(2015). Determinants of death anxiety in patients with advanced cancer. BMJ Supportive & Palliative Care, 5(4), 373–380. https://doi.org/10.1136/bmjspcare-2012-000420

22.

Ren

X. J.

(2018). Research on the acceptance of advance care planning for elderly patients Master's thesis. Shanxi Medical University.

23.

Rhee

J. J.

Zwar

N. A.

Kemp

L. A.

(2013). Advance care planning and interpersonal relationships: A two-way street. Family Practice, 30(2), 219–226. https://doi.org/10.1093/fampra/cms063

24.

Sung

Ferlay

Siegel

R. L.

Laversanne

Soerjomataram

Jemal

Bray

(2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660

25.

Tay

Chia

S. E.

Sng

(2010). Knowledge, attitudes and practices of the advance medical directive in a residential estate in Singapore. Annals Academy of Medicine Singapore, 39(6), 424–428. https://pubmed.ncbi.nlm.nih.gov/20625616

26.

Templer

D. I.

(1970). The construction and validation of a death anxiety scale. The Journal of General Psychology, 82(2d Half), 165–177. https://doi.org/10.1080/00221309.1970.9920634

27.

Trapani

Ginsburg

Fadelu

Lin

N. U.

Hassett

Ilbawi

A. M.

Anderson

B. O.

Curigliano

(2022). Global challenges and policy solutions in breast cancer control. Cancer Treatment Reviews, 104, Article 102339. https://doi.org/10.1016/j.ctrv.2022.102339

28.

Shen

(2022). When cultural values meets professional values: A qualitative study of Chinese nurses' attitudes and experiences concerning death. BMC Palliative Care, 21(1), 181. https://doi.org/10.1186/s12904-022-01067-3

29.

Yang

Sun

Luo

Yang

Ding

Zhou

Liu

Garg

Jackson

Chen

Xiang

Y. T.

(2022). Network connectivity between fear of cancer recurrence, anxiety, and depression in breast cancer patients. Journal of Affective Disorders, 309, 358–367. https://doi.org/10.1016/j.jad.2022.04.119

30.

Yusoff

Ismail

Abd Manaf

M. R.

Ismail

Abdullah

Muhammad

Abdullah Suhaimi

S. N.

Mat Zin

R. R.

(2022). Quality of life of women with breast cancer in a tertiary referral university hospital. Health and Quality of Life Outcomes, 20(1), 15. https://doi.org/10.1186/s12955-022-01921-1