Community Dwelling Cancer Survivors' Perception and Readiness for Advance Care Planning: An Interpretive Description...

This study aimed to explore perceptions and readiness to engage in advance care planning (ACP) among community-dwelling cancer survivors.

An interpretive description qualitative study with reflexive thematic analysis.

Cancer survivors who had completed primary cancer treatment and had not previously completed ACP were recruited from community settings in Singapore. Audio- and video-recorded semi-structured online interviews were conducted. The interviews were analysed using reflexive thematic analysis.

Twenty-one adult cancer survivors who had completed primary cancer treatment and had not previously embarked on an ACP discussion participated in the study. Two themes and six subthemes emerged: (1) Personal and relational perceptions towards advance care planning and (2) Illness and psychosocial contexts influence readiness for advance care planning were elucidated. Participants valued ACP for preserving autonomy and reducing potential burden on their families, but often perceived its relevance as contingent on future deterioration. Perceived recovery or clinical stability could therefore position ACP as something to be deferred. Readiness to engage was further shaped by emotional preparedness, cultural and familial considerations, informational needs and healthcare-system support.

Cancer survivors view ACP as a tool to preserve autonomy and control. Their engagement towards ACP is dynamic and shaped by relational values, sociocultural norms, and evolving perceptions of illness.

Proactive, culturally sensitive and nurse-led approaches are needed to address misconceptions, support emotional readiness and facilitate meaningful ACP discussions throughout the survivorship trajectory.

This study highlights a paradox in cancer survivorship whereby clinical stability may create an opportunity for ACP while simultaneously reducing its perceived relevance. Findings also suggest that overall readiness may coexist with emotional hesitation, supporting approaches to ACP that attend to personal, familial and structural dimensions of readiness rather than assuming uniform preparedness to engage.