Advance care planning in primary care for cancer patients: Feasibility randomised trial

Background: Advance (anticipatory) care planning (ACP) requires discussions between patients and healthcare professionals about planning for future deterioration in health. ACP improves care coordination but uptake is limited and often deferred. Aim: We assessed the feasibility and acceptability to patients, carers and general practitioners (GPs) of a primary care ACP intervention for people with incurable oesophageal, gastric or pancreatic cancer. Design and Setting: 12-month feasibility randomised controlled trial in a Scottish Cancer Network. Method: Patients aged 18 or over starting palliative oncology treatment were randomised 1:1 to an ACP intervention or standard care. Intervention patients received an oncologist letter supporting them to request a GP review and ACP public information. Pre-specified analyses included trial recruitment and retention, ACP completion, and quality of life questionnaires (EQ-5D-5L, ICECAP-SCM) at baseline, 6, 12, 24 and 48 weeks. Qualitative interviews with purposive sampling explored patient, carer and GP experiences. Results: Of 99 eligible participants (269 screened), 46% were recruited (n=46) and randomised; 25 to intervention and 21 to control. By 12 weeks, 45% (9/20) intervention patients and 59% (10/17) controls had a documented ACP. Quality of life was maintained at 24 weeks except for physical symptoms but 30% had died. Social norms associating ACP with dying were prevalent among 23 participants interviewed. No psychological or clinical harms were identified. Conclusion: An RCT of ACP for people with incurable cancer in primary care is feasible. Acceptability and timing of care planning depended on patient, carer and GPs attitudes and behaviours. ClinicalTrials.gov Identifier: NCT03719716. Funder: Macmillan