Table 2 Oncologists Views

Initiation of ACP discussions

… the majority of my patients, 99% of my patients are presenting with an incurable disease. But they’re treated. I don’t discuss those issues until I feel that there are no more treatment options, or the patients cannot tolerate the treatment and we should stop. Then comes the conversation about advance planning.

[Participant 7]

Navigating patient-family dynamics

So that’s the downside of advance planning. It’s actually different for the patient and the family. So, it’s actually often much more accepted by the patient. And the patient comes to terms with it a lot quicker than the family. And there’s many … You know, one of the difficulties is the patient who comes in here and their family wants to be aggressive, and they don’t.

[Participant 3]

Limited formal training in ACP

… so we have a case … We’ve inserted some videos in there. … we’ve introduced the concept. The same method I learned about breaking bad news. So it’s in there. It’s the only mandatory reading actually. And then some videos on people doing it well. [Participant 10]

So that’s part of the teaching. I let them carry on the conversation and telling me what they think and how would they approach. But that’s their learning pattern. This is very informal, okay. But it’s with the patient …. At some point they will develop their own style, yes.

[Participant 7]

ACP requires a team approach

… somebody shows up and really nothing has been done, and then I look in the system and I’m like, you know what, this person has seen like 3 surgeons, has seen the rad onc [sic], has seen all these … What were they all doing? You know, why should it be left to me to fix everything in one appointment? Well, I cannot fix everything in one appointment. So I prioritize and I try and do what I can. But if I can’t get everything done in one appointment, especially in someone who I know has been seeing lots of other people, well, they’re going to come back to see me. [Participant 8]

What’s very interesting is they [patients] can be 90 years old and they’ll have never talked about it [ACP]. Which again, it doesn’t matter if you’ve got cancer or not, the fact that no family physicians ever brought it up with them either is interesting.

[Participant 10]

It’s always proven that the early involvement of a supportive care team or a palliative care team has such a huge impact in terms of patient satisfaction but also in terms of management issues in terms of quality of life and even in terms of survival.

[Participant 6]

Lack of coordinated systems hinders ACP

It would be helpful to have one provincial approach that’s appropriately communicated to all healthcare providers so that we can consistently in the same way communicate to patients and family members …. There should be one source of documentation, right … That we have that advance care planning documentation on there so that with one click, we know. Right now we have to go to 5 or 6 different health records, and then we still may not get it.”

[Participant 6]