Factors related to advance care planning from the perspectives of cancer patients: a systematic review

Abstract

Abstract Introduction: Advance care planning (ACP) has recently been considered as an important component of palliative care for patients with advanced cancer and is a process through which patients express their preferences and goals regarding end-of-life care and make decisions regarding their future treatment priorities. Therefore, the present systematic review investigated the factors related to ACP from the perspective of cancer patients. Methods: A systematic review study was searched in four scientific databases: PubMed, Medline, Scopus, Web of Science, and ProQuest using with related keywords and without date restrictions. The quality of the studies was assessed using the Hawker criterion. The research papers were analyzed as directed content analysis based on the theory of planned behavior. Results: Out of 5900 research papers found, 21 were included in the study. The perspectives of 9061 cancer patients were investigated, of whom 4347 were men and 4714 were women. The mean ± SD of the patients' age was 62.04 ±6.44. According to TPB, factors affecting ACP were categorized into four categories, including attitude, subjective norm, perceived behavioral control, and external factors affecting the model. The attitude category includes two subcategories: "Lack of knowledge of the ACP concept " and " Previous experience of the disease", the subjective norm category includes three subcategories: "Social support and interaction with family", "Respecting the patient's wishes" and "Prioritizing EOL care". Also, the category of perceived control behavior was categorized into three sub-categories: "Decision-making", "Participation in life activities" and " Support from healthcare system ", as well as external factors affecting the model, including "demographic characteristics". Conclusion: The studies indicate that attention to EOL care and the wishes of patients regarding receiving medical care and preservation of human dignity, the importance of facilitating open communication between patients and their families, and different perspectives on providing information, communicating bad news and making decisions require culturally sensitive approaches. Finally, the training of cancer care professionals in the PC practice, promoting the participation of health care professionals in ACP activities and creating an ACP-positive attitude should be strongly encouraged.