Preparedness for end-of-life in patients with advanced metastatic cancer enrolled in a clinical trial (phase I/phase II)

Patients with advanced metastatic cancer enrolled in a phase I clinical trial have a life expectancy of less than nine months. Advance care planning (ACP) is a means of tailoring care to patients’ needs, especially at the end-of-life (EOL). An extensive review of literature identified a positive impact of ACP conversations on patients with cancer including increased decision making for EOL care preferences. Unfortunately, there is little or no information available on their preparedness for EOL, indicating a gap in literature. This study aims to describe the preparedness for EOL, and evaluate the effect of quality of communication (in ACP discussions) on preparedness for EOL in patients with advanced metastatic cancer enrolled in a clinical trial (phase I/phase II) who had ACP discussion with a health care provider. A non-experimental descriptive study design was utilized, participants were recruited from the inpatient unit at a large comprehensive cancer center. The data was collected through REDCap, and was measured with surveys QUAL-EC for preparedness for EOL and QOC for quality of communication. The SPSS version 28.0 analyzed the data, the results indicated 56.8% (n=81) well prepared and 43.2% (n=81) not well prepared for the EOL. Md = 3.5 (IQR: 3.0, 4.1). There was a significant moderate relationship between quality of communication and EOL preparedness, r = .38, n = 81, p < .001, although the effect was only 14.4% (shared variance R2 = 14.4). The results of this study indicate a need for improvement in preparedness for EOL in this patient population. Quality communication skills are essential for addressing patients’ uncertainty, and emotional distress related to EOL discussions and decision-making. Oncology nurses have a vital role in cancer care, trusting relationships with patients and families, and can be trained to develop the communication skills necessary for engaging their patients in difficult conversations that can elicit their fears and worries related to EOL. Coordination between nurses, the healthcare team, and patients’ families can provide the support needed for preparedness for EOL in patients with advanced metastasis that ultimately results in quality of life, quality of care, and quality of death.