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Cancer advance care planning: development of a screening tool
  1. Pia Berlin1,
  2. Lena Göggelmann2,
  3. Svenja Herzog2,
  4. Anna J Pedrosa Carrasco2,3,
  5. Johannes Hauck1,
  6. Nina Timmesfeld4,
  7. Johannes Kruse5,
  8. Winfried Rief1,
  9. Jorge Riera Knorrenschild6,
  10. Pia von Blanckenburg1 and
  11. Carola Seifart2
  1. 1Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
  2. 2Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
  3. 3Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
  4. 4Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Germany
  5. 5Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Giessen and Marburg, Giessen, Germany
  6. 6Department of Haematology, Oncology and Immunology, University Hospital of Giessen and Marburg, Marburg, Germany
  1. Correspondence to Pia Berlin, Department of Psychology, Philipps-Universitat Marburg, Marburg 35037, Germany;{at}; Dr Pia von Blanckenburg; blanckep{at}


Objectives Advance care discussions are a useful communication tools for medical preferences and beneficial for shared decision-making processes in hospital settings. The present study developed the first screening tool for need for advance care planning (ACP).

Methods In phase 1 (n=92), items were evaluated using feasibility analysis and item reduction. In phase 2 (n=201), reduced screening items were analysed for predictive value of need for ACP. Statistical analysis included receiver-operating characteristics analysis (area under the curve>0.80), optimal cut-off based on sensitivity and specificity, interpretation of OR and construct validity using correlation with death anxiety, communication avoidance within families and trust based on the relationship with the treating physician.

Results Participants in both phases were approximately 60 years old with non-curative prognosis. After item reduction, predictive values of four possible items with good item difficulty and discrimination were compared for mild, moderate and great levels of death anxiety. A two-item combination of I am burdened by thoughts of an unfavourable course of the disease and I am burdened by the feeling of being ill-prepared for the end of life showed best prediction of death anxiety and communication avoidance. Clinical cut-off at sum-score ≥6 was of high sensitivity (95%) and specificity (81%). Previous use of social support and readiness for ACP was related to higher chance of interest in ACP.

Conclusion Screening for need of ACP is possible with two objective items and one subjective item. Positive screening therefore indicates when to offer ACP discussions and provides routine estimation of ACP need in clinical practice.

  • Cancer
  • Clinical assessment
  • End of life care
  • Hospital care

Data availability statement

Data relevant to study objective will be presented upon reasonable request in fully anonymised form only.

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Data availability statement

Data relevant to study objective will be presented upon reasonable request in fully anonymised form only.

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  • PvB and CS are joint senior authors.

  • PvB and CS contributed equally.

  • Contributors PB contributed to item development, planning and realisation of the study, recruitment, advance care plan provision, data analysis, draft and review of the manuscript. LG and JH contributed to item development, recruitment and assessments. SH contributed to item development, planning and advance care plan provision. AJPC contributed to recruitment, advance care plan provision and review of manuscript. NT contributed to planning and data analysis. JRK contributed to planning and realisation of study, recruitment and supervision of advance care planning provision. JK and WR contributed to planning and realisation of the study. CS and PVB contributed equally to item development, planning, realisation of the study and review of the manuscript. All authors accepted to final manuscript draft for publication. PB, CS and PVB are responsible for the overall content.

  • Funding The present study was funded by the German Ministry of Education and Research (Recipient: CS, Funding ID: 01GY1708) and German Cancer Aid Foundation (Recipient: PvB, Funding ID: 70113532).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.