Abstract
Context
Personal values are individual conceptions of the desirable appraisals and actions
that guide our attitudes and behaviour. Advance care planning (ACP) now emphasises
the consideration of personal life goals and values expressed as a Values Directive
(VD) to guide discussions concerning medical treatment.
Objective
To investigate the diversity of values, experiences and adaptations expressed in cancer
patients VDs.
Methods
Contents of the VDs of ACPs of cancer patients who participated in a randomised control
trial comparing a video intervention showing values communication between cancer patient-caregivers
with usual care were analysed. Qualitative phenomenological content analysis was used
to understand how participants made meaning of their lived experiences.
Results
Forty-two participants completed an ACP (37.2% response rate), with 97.6% of these
completing a VD (57.1% female, mean age 72 years, 30.1% gastrointestinal cancer).
Participants described diverse adjustments to frailty and adaptive coping with deteriorating
functionality. Emotional and financial concerns were eased through experiencing benevolence
and trust established through family and friendship bonds and reciprocation of care.
Death anxiety and ambivalence were expressed concurrently with the experiential acceptance
of dying. Secular and sacred rituals featured as an affirmation of their faith or
beliefs.
Conclusion
Cancer patients seek to make meaning of their experiences, concurrently posturing vulnerability and resilience, despite conflicting emotions and
experiences. Given that the choices people make as they approach dying relate to their
most deeply held values, ACP conversations should explore how patients draw from their
values and life goals to optimise their adaptations to illness.
Key Words
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Article info
Publication history
Published online: August 03, 2022
Accepted:
July 27,
2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. All rights reserved.
