Advance care planning in the last year of life of patients with advanced cancer: patients' perspectives on decision-making and their family and physicians' awareness of future care preferences.

Authors

Christina A M de Laat, Helen P A Driessen, Ida J Korfage, Anna K L Reyners, Marieke H J van den Beuken-van Everdingen, Alexander de Graeff, Mathijs P Hendriks, Jarmo C B Hunting, Wouter K de Jong, Evelien J M Kuip, Hanneke W M van Laarhoven, Caroline M P W Mandigers, Annemieke van der Padt-Pruijsten, Dirkje W Sommeijer, Martine F Thijs, Marian A Tiemessen, Lia van Zuylen, Natasja J H Raijmakers

Published in

Journal of cancer survivorship : research and practice. Jul 13, 2026. Epub Jul 13, 2026.

Abstract

Advance care planning (ACP) is increasingly embedded in clinical practice. This study assesses perspectives of patients with advanced cancer on elements of ACP during their last year of life and identifies associated sociodemographic, clinical, and healthcare-related factors.
We used longitudinal data from the prospective, multicenter observational eQuiPe study (2017-2021) among patients with solid advanced cancer who died during follow-up. From inclusion until death, patients completed 3-monthly questionnaires, including three statements derived from the ACTION trial, assessing their involvement in decision-making and their perceived awareness of future care preferences by family/friends and physicians. Elements of ACP were aggregated into a mean ACP score (range 0-100). Changes over time and associated factors were analyzed using linear mixed models.
Data from 626 deceased patients (mean age 66 years, 50% male) were analyzed. Throughout their last year of life, most felt consistently involved in care decisions (88-91%), and perceived awareness by family/friends (84-88%) and physicians (81-85%) regarding their future care preferences. ACP scores were positively associated with social support (β = 6.71;p < 0.001), peace/meaning (β = 0.23;p = 0.034), satisfaction (β = 1.94;p < 0.001) and continuity of care (β = 0.65;p = 0.002), and negatively with physical functioning (β = -0.82;p < 0.001).
Elements of ACP remained unchanged as death approached. Higher ACP scores were associated with better experienced care, better social and spiritual functioning, and worse physical functioning.
Most patients reported being involved in elements of ACP, and those who felt more involved also rated their care more positively. Promoting conversations about future care preferences with family, friends, and physicians can help ensure that care reflects what matters most to patients.

PMID:
42440050
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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