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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

Christina A. M. de LaatNetherlands Comprehensive Cancer OrganisationH E DriessenDepartment of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The NetherlandsI KorfageDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The NetherlandsAnna K. L. ReynersUniversity of GroningenM.H.J. van den Beuken-van EverdingenCenter of Expertise for Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The NetherlandsAlexander de GraeffDepartment of Medical Oncology, University Medical Center Utrecht, The Netherlands; Academic Hospice Demeter, Utrecht, De Bilt, The NetherlandsMathijs P. HendriksDepartment of Medical Oncology, Northwest Clinics, Alkmaar, The NetherlandsJarmo C. B. HuntingDepartment of Medical Oncology, St. Antonius Hospital, Utrecht, The NetherlandsWouter K. de JongDepartment of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The NetherlandsVan Der KüipDepartment of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The NetherlandsH A Van LaarhovenDepartment of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The NetherlandsCaroline M.P.W. MandigersDepartment of Medical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The NetherlandsAnnemieke van der Padt‐PruijstenDepartment of Internal Medicine, Maasstad Hospital, Rotterdam, The NetherlandsDirkje W. SommeijerMartine F. ThijsDepartment of Medical Oncology, Ikazia Hospital, Rotterdam, The NetherlandsM. TiemessenDepartment of Pulmonology, Dijklander Hospital, Hoorn, The NetherlandsLia van ZuylenDepartment of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The NetherlandsNatasja J. H. RaijmakersDepartment of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands

2026en

ABI

Annotatsiya

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. IMPLICATIONS FOR CANCER SURVIVORS: 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.

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DOI: 10.1007/s11764-026-02080-8

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