Planning for Future Care with Patients with Advanced Cancer
Research type
Research Study
Full title
Planning for Future Care with Patients with Advanced Cancer: Examining the feasibility of using the Trajectory Touchpoint Technique for Advance Care Planning.
IRAS ID
261984
Contact name
John Ellershaw
Contact email
Sponsor organisation
Research Development and Innovation - Royal Liverpool & Broadgreen University Hospitals Trust
Clinicaltrials.gov Identifier
4766, University of Liverpool Central University Research Ethics Committee for Physical Interventions
Duration of Study in the UK
0 years, 6 months, 0 days
Research summary
Research Summary
Planning for Future Care with Patients with Advanced Cancer.\n\nResearch Question: “Is the Trajectory Touchpoint Technique feasible to support Advance Care Planning conversations in patients/families with advanced cancer.”\n\nAdvance Care Planning (ACP) is a process where patients (and their families if appropriate) discuss with their care team what may happen as their illness progresses, including how they (and their family) would like to be supported and cared for. The discussion of expectations and choices for care can then be formally recorded and used to guide and inform future care. Well-documented benefits of ACP include empowering patients and their families to better understand available choices and make informed decisions regarding future care and prepares all for the end of life. However, few people with a life limiting illness (such as cancer) have an ACP. Patients and families often find future and end of life care a difficult subject to discuss, as do doctors/nurses, who fear upsetting patients and families and who may have limited training/experience in how to prompt and record ACP discussions.\n\nThis project aims to overcome the barriers in discussing ACP by using the Trajectory Touchpoint Technique. The technique has been used in over 200 interviews discussing hospice care experiences. It uses rich but simple cartoon pictures to sensitively facilitate difficult conversations at a detailed level, enabling people to raise sensitive and potentially distressing topics at a pace they are comfortable with, rather than responding to numerous pre-determined questions.\n\nThis project will test whether the technique can be used to facilitate ACP discussions by developing an ACP specific tool and trialing this with patients (and their families) with advanced cancer on the Palliative Care Ward of The Royal Liverpool University Hospital. Patients, family members and clinical staff will then be interviewed about their experiences with this proposed service improvement.Summary of Results
Every participant felt that the pictures were easy to talk about and that the approach helped them in their ACP conversation. Patients and relatives commented that it is a good way to start a conversation: “Yeah, I think it’s a good starter if they’re not doing it or they don’t know where to start” (Relative). “This is for kids. But I can apply it to myself which is fascinating. Simplicity!” (Patient). The clinicians also found the approach a helpful way to start a conversation: “positive introduction to the conversation. And I think that’s how it should be. It’s sort of what’s important to you and then you move from that into other areas” (Clinician).
The pictures were chosen to represent important topics for patients at end of life or with life limiting illnesses. Participants understood the images and chose to talk about the ones they felt were important for them: “[That image] still strike me… Well, it’s me husband and meself” (Patient). The cartoons also helped to soften the conversation without taking away any importance, as can be seen in the cheery way that participants responded to some of the pictures: “… And I thought, ‘Well that’s me and you’ [Laughs]” (Relative). Other pictures have shown patients that it is okay to talk about what they want, when they are ready to talk about it: “People have also looked at that [image] and said immediately where they want to be when they die… which sometimes is a difficult thing to raise. Particularly when someone’s earlier in their journey or trajectory in terms of cancer” (Clinician).
Clinicians said that the TTT pictures also help staff to understand and to become more comfortable with ACP, as is shown by this comment: “She [junior colleague] actually did say, ‘Oh, it’s not as scary as I thought it was.’ So, yeah, I think it would help these people into ACP conversations really” Clinician.Findings
• The TTT approach helped patients to start talking about the things they felt comfortable with and that were most important to them.
• The TTT pictures helped relatives to know what was okay to talk about.
• Clinicians found the visual aid helped focus the talk.
• People reacted to the pictures that had meaning for them in an open and honest way.
• Clinicians felt that the ACP with the TTT approach helped to make the talk deeper than those they had done in the past.REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
19/YH/0165
Date of REC Opinion
29 May 2019
REC opinion
Favourable Opinion