Planning for Future Care With Patients With Advanced Cancer

Advance Care Planning (ACP) is a process where patients (and their families if appropriate) discuss with their doctors and nurses 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; This ensures care is based on what is important to that patient (and their family) 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. This project aims to overcome the barriers in discussing ACP by using the Trajectory Touchpoint Technique. The technique utilises a range of existing service evaluation and service design methods found in "service management" and "design systems". Rich pictures are used in the form of cartoons on an electronic tablet or printed card, to enable patients/families to lead discussions. The images are simple and enable people to raise sensitive and potentially distressing topics at a pace they are comfortable with, rather than responding to numerous pre-determined questions. The technique was originally designed to explore the experiences of patients (and their families) of Hospice Care and has been successfully used in over 200 interviews, demonstrating an ability to sensitively facilitate difficult conversations whilst enabling rich and detailed discussion.