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Advance care planning for patients with cancer and family caregivers in Indonesia: a qualitative study.
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- Author(s): Martina, Diah; Kustanti, Christina Yeni; Dewantari, Rahajeng; Sutandyo, Noorwati; Putranto, Rudi; Shatri, Hamzah; Effendy, Christantie; van der Heide, Agnes; van der Rijt, Carin C. D.; Rietjens, Judith A. C.
- Source:
BMC Palliative Care; 11/23/2022, Vol. 21 Issue 1, p1-12, 12p- Subject Terms:
THERAPEUTICS; CANCER patient psychology; CAREGIVERS; ACADEMIC medical centers; ATTITUDE (Psychology); RESEARCH methodology; FAMILIES; INTERVIEWING; TERTIARY care; ADVANCE directives (Medical care); PATIENTS' attitudes; HEALTH; INFORMATION resources; DESCRIPTIVE statistics; DECISION making in clinical medicine; THEMATIC analysis; CANCER patient medical care; RELIGION - Source:
- Additional Information
- Subject Terms:
- Abstract: Background: Individuals' willingness to engage in advance care planning is influenced by factors such as culture and religious beliefs. While most studies on advance care planning in Asia have been performed in high-income countries, Indonesia is a lower-middle-income country, with a majority of strongly collectivist and religiously devout inhabitants. We studied the perspectives of Indonesian patients with cancer and family caregivers regarding advance care planning by first exploring their experiences with medical information-disclosure, decision-making, and advance care planning and how these experiences influence their perspectives on advance care planning. Methods: We conducted semi-structured interviews among 16 patients with cancer and 15 family caregivers in a national cancer center in Jakarta and a tertiary academic general hospital in Yogyakarta. We performed an inductive thematic analysis using open, axial, and selective coding. The rigor of the study was enhanced by reflective journaling, dual coding, and investigator triangulation. Results: Twenty-six of 31 participants were younger than 60 years old, 20 were Muslim and Javanese, and 17 were college or university graduates. Four major themes emerged as important in advance care planning: (1) participants' perceptions on the importance or harmfulness of cancer-related information, (2) the importance of communicating bad news sensitively (through empathetic, implicit, and mediated communication), (3) participants' motives for participating in medical decision-making (decision-making seen as patients' right or responsibility, or patients' state of dependency on others), and (4) the complexities of future planning (e.g., due to its irrelevance to participants' religious beliefs and/or their difficulties in seeing the relevance of future planning). Conclusions: Culturally sensitive approaches to advance care planning in Indonesia should address the importance of facilitating open communication between patients and their families, and the various perspectives on information provision, bad news communication, and decision-making. Advance care planning should focus on the exploration of patients' values, rather than drafting treatment plans in advance. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of BMC Palliative Care is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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