Patient Engagement With Early Stage Advance Care Planning at a Comprehensive Cancer Center - Study Summary

Sep 24, 2026

Advance care planning (ACP) relies on establishing care preferences and selecting a prepared medical decision-maker (MDM), but systematic ACP in oncology is uncommon. This study assessed a social work (SW)-driven process that counseled new gynecologic cancer patients to select and prepare a prepared MDM. Using a pre/post design with baseline and 3-month follow-up, the study evaluated medical power of attorney (MPOA) document completion and factors linked to completion. A SW intervention did not significantly engage patients, though care preference change and weak-to-moderate caregiver-patient agreement were observed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Implications for Practice

Introduction

Patient Engagement With Early Stage Advance Care Planning at a Comprehensive Cancer Center Donna S. Zhukovsky1,*,, Pamela Soliman2, Diane Liu3, Margaret Meyer4, Ali Haider1, Yvonne Heung1, Susan Gaeta5, Karen Lu2, Karen Stepan6, Penny Stanton1, Alma Rodriguez7,, Eduardo Bruera1 1Department of Palliative Care Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 2Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 3Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 4Department of Social Work, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 5Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 6Department of Medical Affairs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 7Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA * Corresponding author: Donna S. Zhukovsky, MD, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX 77030, USA. Tel: +1 713 792 3937; Fax: +1 713 792 6092; Email: [dzhukovs@mdanderson.org](dzhukovs@mdanderson.org) Abstract Background: Establishing care preferences and selecting a prepared medical decision-maker (MDM) are basic components of advance care planning (ACP) and integral to treatment planning. Systematic ACP in the cancer setting is uncommon. We evaluated a systematic social work (SW)-driven process for patient selection of a prepared MDM. Methods: We used a pre/post design, centered on SW counseling incorporated into standard-of-care practice. New patients with gynecologic malignancies were eligible if they had an available family caregiver or an established Medical Power of Attorney (MPOA) . Questionnaires were completed at baseline and 3 months to ascertain MPOA document (MPOAD) completion status (primary objective) and evaluate factors associated with MPOAD completion (secondary objectives) . Results: Three hundred and sixty patient/caregiver dyads consented to participate. One hundred and sixteen (32%) had MPOADs at baseline. Twenty (8%) of the remaining 244 dyads completed MPOADs by 3 months. Two hundred and thirty-six patients completed the values and goals survey at both baseline and follow-up: at follow-up, care preferences were stable in 127 patients (54%), changed toward more aggressive care in 60 (25%), and toward the focus on the quality of life in 49 (21%) . Correlation between the patient’s values and goals and their caregiver’s/ MPOA’s perception was very weak at baseline, improving to moderate at follow-up. Patients with MPOADs by study completion had statistically significant higher ACP Engagement scores than those without. Conclusion: A systematic SW-driven intervention did not engage new patients with gynecologic cancers to select and prepare MDMs. Change in care preferences was common, with caregivers’ knowledge of patients’ treatment preferences moderate at best. Key words: advance care planning; advance directives; goal-concordant care; medical power of attorney; surrogate medical decision-maker. Implications for Practice New patients with gynecologic cancers did not engage in a systematic process to select and prepare a surrogate medical decision-maker (MDM), such as a Medical Power of Attorney, important when unable to communicate with the medical team. Many patients changed their cancer treatment preferences over a 3-month period. The correlation of caregivers’ perception of patients’ treatment goals with patients’ was moderate at best. To better promote goal-concordant care, new paradigms of advance care planning (ACP) are needed to prepare patients and their surrogate MDMs for more dynamic medical decision-making than that afforded by advance directives and traditional ACP approaches. Introducti

FAQs

What was the purpose of the study on early stage ACP engagement?

To evaluate whether a systematic social work (SW)-driven process could help new gynecologic cancer patients select and prepare a prepared medical decision-maker (MDM) as part of advance care planning (ACP).

How was the study conducted and what was measured?

The study used a pre/post design with SW counseling integrated into standard care. Questionnaires at baseline and 3 months assessed medical power of attorney document (MPOAD) completion and factors associated with completion, along with values and goals and care preference changes.

What did the study find about MPOAD completion and patient engagement?

At baseline, 32% had MPOADs. By 3 months, 8% of the remaining dyads completed MPOADs, and the SW-driven intervention did not engage new patients to select and prepare MDMs. Care preferences changed for many patients over the 3-month period.

Sep 24, 2026

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