Barriers and Facilitators of Advance Care Planning in Patients With Cancer: A Qualitative Study

ABSTRACT

Background

Advance Care Planning (ACP) has the potential to enhance end-of-life care and improve the allocation of healthcare resources for patients with cancer. However, its successful implementation requires considerable effort to overcome challenges and deliver health benefits. Healthcare providers and patients are key players in ACP, and their perceptions of the process must be understood to address implementation challenges effectively.

Aims and Objectives

To identify barriers and facilitators to ACP implementation in Chinese oncology settings, providing a foundation for culturally appropriate healthcare strategies.

Methods

A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews (n = 30) were conducted between April and August 2022 to synthesise the perspectives of nurses, physicians, patients with cancer and their families who had participated in ACP. Data were analysed using a directed qualitative content analysis approach, and reporting followed the SRQR guidelines.

Results

Twenty implementation determinants were identified across four CFIR domains, including 13 barriers and 7 facilitators. Key barriers included limited adaptability of ACP to local cultural and family norms, high complexity of ACP processes, insufficient knowledge and skills among clinicians, unclear team responsibilities, low organisational readiness, limited resources and poor public awareness. Facilitators included strong team culture, clinician motivation, supportive leadership and alignment with national policies. Two determinants showed mixed influences: the relative advantage of ACP compared to existing practices, and the extent of collaboration with external organisations.

Conclusions

Our study highlights the challenges of implementing ACP in China, as well as the unique and specific barriers to implementation. These findings contribute to a deeper understanding of context-specific determinants and offer actionable insights to inform the development of culturally tailored ACP implementation strategies in resource-limited healthcare settings.

Relevance to Clinical Practice

To inform the development of implementation strategies to promote ACP in healthcare systems dominated by traditional medicine.

Post-marketing safety of solriamfetol: A retrospective pharmacovigilance study based on the us food and drug administration adverse event reporting system

by Lingling Wu, Kaijian Zhu

Excessive daytime sleepiness (EDS) seriously affects quality of life and may increase the risk of life-threatening situations, such as motor vehicle accidents. Solriamfetol is a novel medication approved for the treatment of EDS and serves as an alternative to traditional stimulants. This retrospective pharmacovigilance study aimed to analyze adverse events (AEs) related to solriamfetol based on real-world data.

Data regarding solriamfetol-related adverse events were retrieved from the FDA Adverse Event Reporting System (FAERS) from Q3 of 2019 to Q1 of 2024. A total of 1550 reports on solriamfetol-related AEs were analyzed using disproportionality analysis to identify AE signals across various organ systems.

A large proportion of AEs were reported among female patients (64.06%), primarily including those with narcolepsy (38.13%) and obstructive sleep apnea (3.68%). The most frequently reported AEs included headache, anxiety, and drug ineffectiveness, with 46.8% of AEs occurring within 7 days of treatment initiation. Furthermore, solriamfetol was significantly associated with psychiatric and nervous system disorders as well as cardiac and general disorders.

Solriamfetol-related adverse events were mainly psychiatric, neurological, cardiac, and general disorders, with headache, anxiety, and drug ineffectiveness being the most common. Nearly half of the events occurred within the first week of treatment. Given the limitations of the FAERS database, further prospective studies are needed to confirm these findings.