# The value of home-based advance care planning in addressing existential concerns among older Norwegian patients with cancer and their relatives: A narrative ethnographic study

## TL;DR

Home-based advance care planning helps older cancer patients and their families address existential concerns and improve end-of-life decision-making.

## Contribution

This study explores how home-based ACP conversations support existential discussions and influence family dynamics in palliative care.

## Key findings

- Home-based ACP conversations help patients and relatives discuss existential fears and decision-making.
- These conversations influence family interactions and improve informed decision-making about future care.
- The home environment facilitates discussions about past, present, and future lives during ACP.

## Abstract

The importance of holistic and person-centered palliative care is widely recognized, but the existential dimensions remain less focused. There is a need for more knowledge about the existential content in advance care planning (ACP) and the significance thereof in the context of home-based palliative care from the perspective of patients and their relatives.

This study aimed to explore home-based ACP as an existential conversation when conducted as a part of a palliative-care coordination meeting, and how older home-dwelling patients with advanced cancer and their relatives experience its significance.

A narrative ethnographic design was employed.

The reported empirical material is based on participant observations of the home-based ACP conversations and follow-up interviews with eight patients and their relatives. The analytical approach was guided by the theoretical framework of narrative ethnography.

The ACP conversations strongly supported the patients and their relatives in discussing existential concerns, such as existential fear, lived lives, and decision-making at the end of life. The significance of these conversations extended beyond the initial conversation by profoundly influencing subsequent family interactions and enhancing their ability to make informed and meaningful decisions regarding future medical treatment and care.

Home-based ACP can be a valuable approach for addressing the existential concerns of older patients and their relatives in the final stages of life. Home-based ACP conversations start a process that continues within the family context and affects their relational dynamics and communication patterns. This study indicates that the home environment fosters discussions about past, present, and future lives, shaping the content and outcomes of home-based ACP.