Experiences of cancer patients in palliative care with advanced care planning: A systematic review and meta-synthesis of qualitative studies

Purpose: This systematic review and meta-synthesis aims to synthesize the perspectives and experiences of patients with advanced cancer of advanced care planning and advanced directives in a PC setting. Methods: Qualitative studies published between 1991 and 2024 were included. A comprehensive search was performed across six electronic databases: CINAHL, Cochrane, OVID, PubMed, Scopus, and ScienceDirect. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was applied for quality assessment. Thematic synthesis was applied to analyze data from 20 selected studies, involving 534 participants. Results: Six key themes emerged: (1) Meaning of advanced care planning (ACP), (2) Initiating ACP, (3) Barriers and facilitators, (4) Communication in ACP, (5) Outcomes of ACP, and (6) Needs and wishes in ACP. Findings highlight ACP as a complex and dynamic process shaped by emotional, social, and institutional factors. While ACP promotes patient autonomy and reduces anxiety, reluctance, avoidance, and cultural barriers limit engagement. Effective clinician-patient communication, emotional readiness, and tailored interventions enhance ACP participation. Conclusions: Understanding the perspectives of advanced cancer patients is essential for improving ACP implementation in PC settings. Healthcare professionals must foster trust, provide culturally sensitive communication, and adapt ACP approaches to patients' evolving needs. Future research should focus on addressing emotional and systemic barriers to increase ACP participation and improve end-of-life care quality.