Advance Care Planning Does Not Adversely Affect Hope or Anxiety Among Patients With Advanced Cancer

J Pain Symptom Manage. 2015 Jun;49(6):1088-96. doi: 10.1016/j.jpainsymman.2014.11.293. Epub 2014 Dec 24.


Context: Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress.

Objectives: To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer.

Methods: Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction.

Results: A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P<0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P<0.01) in the Intervention than Control group.

Conclusion: Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being.

Keywords: Advance care planning; anxiety; decision aids; hope.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Advance Care Planning*
  • Aged
  • Anxiety*
  • Decision Making
  • Female
  • Follow-Up Studies
  • Health Knowledge, Attitudes, Practice
  • Hope*
  • Humans
  • Internet
  • Male
  • Middle Aged
  • Neoplasms / psychology*
  • Neoplasms / therapy
  • Patient Satisfaction
  • Personal Autonomy
  • Psychological Tests
  • Single-Blind Method
  • Tertiary Care Centers
  • Treatment Outcome