Timing of advance care planning in patients with advanced cancer: Analysis of ACTION data

Tingting Zhu; Judith Ac Rietjens; Johannes J M van Delden; Luc Deliens; Agnes van der Heide; Anna Thit Johnsen; Francesca Ingravallo; Urška Lunder; Nancy J Preston; Jane Seymour; Ida J Korfage

doi:10.1016/j.pec.2025.108761

Timing of advance care planning in patients with advanced cancer: Analysis of ACTION data

Tingting Zhu^*
, Judith Ac Rietjens
, Johannes J M van Delden
, Luc Deliens
, Agnes van der Heide
, Anna Thit Johnsen
, Francesca Ingravallo
, Urška Lunder
, Nancy J Preston
, Jane Seymour
, Ida J Korfage

^*Corresponding author for this work

Oncology

Research output: Contribution to journal › Article › Research › peer-review

Abstract

OBJECTIVE: To explore the experiences of patients with advanced cancer regarding the timing of ACP.

METHODS: This secondary analysis used data from the ACTION cluster-randomized clinical trial. 288 patients with advanced lung or colorectal cancer, WHO performance status 0-3, and with a minimum life expectancy of 3 months were included in this analysis.

RESULTS: The mean time between patients' cancer diagnosis and the first ACP conversation was 15.3 months (SD:19.4). The average duration from current cancer stage diagnosis to the first conversation was 8.9 months (SD:10.7). The timing of the conversation was perceived as "just right" by 217 (75.3 %) of the patients. Patients who perceived the timing as "too early" were more recently diagnosed with cancer (9.1 months) or with their current cancer stage (5.7 months) than those who did not. Patients perceiving the timing as "too late" had shorter estimated survival times.

CONCLUSION: Patients with advanced cancer may benefit from earlier ACP than what is currently typically initiated in clinical practice.

PRACTICE IMPLICATIONS: When initiating ACP conversations, several aspects should be considered, including patients' gender, their socio-cultural environment, and their ability to perform daily activities, with or without limitations.

Original language	English
Article number	108761
Number of pages	8
Journal	Patient Education and Counseling
Volume	136
Early online date	24 Mar 2025
DOIs	https://doi.org/10.1016/j.pec.2025.108761
Publication status	Published - Jul 2025

Funding

AH declares grant funding for the submitted work from the European Union ' s Seventh Framework Programme FP7/2007 - 2013 under grant agreement n degrees 602541. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Funders	Funder number
European Union	602541

Keywords

Survey
Readiness
Timing
Acp
Cancer
Advance Care Planning
Decision Making
Humans
Middle Aged
Colorectal Neoplasms/psychology
Male
Lung Neoplasms/psychology
Neoplasms
Time Factors
Life Expectancy
Aged, 80 and over
Female
Aged
Communication

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Cite this

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title = "Timing of advance care planning in patients with advanced cancer: Analysis of ACTION data",

abstract = "OBJECTIVE: To explore the experiences of patients with advanced cancer regarding the timing of ACP.METHODS: This secondary analysis used data from the ACTION cluster-randomized clinical trial. 288 patients with advanced lung or colorectal cancer, WHO performance status 0-3, and with a minimum life expectancy of 3 months were included in this analysis.RESULTS: The mean time between patients' cancer diagnosis and the first ACP conversation was 15.3 months (SD:19.4). The average duration from current cancer stage diagnosis to the first conversation was 8.9 months (SD:10.7). The timing of the conversation was perceived as {"}just right{"} by 217 (75.3 \%) of the patients. Patients who perceived the timing as {"}too early{"} were more recently diagnosed with cancer (9.1 months) or with their current cancer stage (5.7 months) than those who did not. Patients perceiving the timing as {"}too late{"} had shorter estimated survival times.CONCLUSION: Patients with advanced cancer may benefit from earlier ACP than what is currently typically initiated in clinical practice.PRACTICE IMPLICATIONS: When initiating ACP conversations, several aspects should be considered, including patients' gender, their socio-cultural environment, and their ability to perform daily activities, with or without limitations.",

keywords = "Survey, Readiness, Timing, Acp, Cancer, Advance Care Planning, Decision Making, Humans, Middle Aged, Colorectal Neoplasms/psychology, Male, Lung Neoplasms/psychology, Neoplasms, Time Factors, Life Expectancy, Aged, 80 and over, Female, Aged, Communication",

author = "Tingting Zhu and Rietjens, \{Judith Ac\} and \{van Delden\}, \{Johannes J M\} and Luc Deliens and \{van der Heide\}, Agnes and Johnsen, \{Anna Thit\} and Francesca Ingravallo and Ur{\v s}ka Lunder and Preston, \{Nancy J\} and Jane Seymour and Korfage, \{Ida J\}",

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doi = "10.1016/j.pec.2025.108761",

language = "English",

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T1 - Timing of advance care planning in patients with advanced cancer

T2 - Analysis of ACTION data

AU - Zhu, Tingting

AU - Rietjens, Judith Ac

AU - van Delden, Johannes J M

AU - Deliens, Luc

AU - van der Heide, Agnes

AU - Johnsen, Anna Thit

AU - Ingravallo, Francesca

AU - Lunder, Urška

AU - Preston, Nancy J

AU - Seymour, Jane

AU - Korfage, Ida J

PY - 2025/7

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N2 - OBJECTIVE: To explore the experiences of patients with advanced cancer regarding the timing of ACP.METHODS: This secondary analysis used data from the ACTION cluster-randomized clinical trial. 288 patients with advanced lung or colorectal cancer, WHO performance status 0-3, and with a minimum life expectancy of 3 months were included in this analysis.RESULTS: The mean time between patients' cancer diagnosis and the first ACP conversation was 15.3 months (SD:19.4). The average duration from current cancer stage diagnosis to the first conversation was 8.9 months (SD:10.7). The timing of the conversation was perceived as "just right" by 217 (75.3 %) of the patients. Patients who perceived the timing as "too early" were more recently diagnosed with cancer (9.1 months) or with their current cancer stage (5.7 months) than those who did not. Patients perceiving the timing as "too late" had shorter estimated survival times.CONCLUSION: Patients with advanced cancer may benefit from earlier ACP than what is currently typically initiated in clinical practice.PRACTICE IMPLICATIONS: When initiating ACP conversations, several aspects should be considered, including patients' gender, their socio-cultural environment, and their ability to perform daily activities, with or without limitations.

AB - OBJECTIVE: To explore the experiences of patients with advanced cancer regarding the timing of ACP.METHODS: This secondary analysis used data from the ACTION cluster-randomized clinical trial. 288 patients with advanced lung or colorectal cancer, WHO performance status 0-3, and with a minimum life expectancy of 3 months were included in this analysis.RESULTS: The mean time between patients' cancer diagnosis and the first ACP conversation was 15.3 months (SD:19.4). The average duration from current cancer stage diagnosis to the first conversation was 8.9 months (SD:10.7). The timing of the conversation was perceived as "just right" by 217 (75.3 %) of the patients. Patients who perceived the timing as "too early" were more recently diagnosed with cancer (9.1 months) or with their current cancer stage (5.7 months) than those who did not. Patients perceiving the timing as "too late" had shorter estimated survival times.CONCLUSION: Patients with advanced cancer may benefit from earlier ACP than what is currently typically initiated in clinical practice.PRACTICE IMPLICATIONS: When initiating ACP conversations, several aspects should be considered, including patients' gender, their socio-cultural environment, and their ability to perform daily activities, with or without limitations.

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KW - Male

KW - Lung Neoplasms/psychology

KW - Neoplasms

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KW - Life Expectancy

KW - Aged, 80 and over

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JO - Patient Education and Counseling

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Timing of advance care planning in patients with advanced cancer: Analysis of ACTION data

Abstract

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Keywords

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