Regardless of whether patients with advanced cancer had completed advance care planning, hope was equivalent, according to the results of an analysis.1 Of 672 patients, 20% reported engaging in a discussion about end-of-life planning, 51% reported completing an advance directive, and 85% had chosen a surrogate.

“We conducted this study due to the fact that many oncologists cite fear of giving up hope as a primary reason they defer conversations about end-of-life or advance care planning until late in the course of a patient’s disease,” says Michael Cohen, MD, the study’s lead author and a fellow in gynecologic oncology at UPMC Magee-Womens Hospital in Pittsburgh.

Researchers found there was little truth to this. The results revealed no association between hope and advance care planning. “Advance care planning conversations allow patients with terminal diagnoses to guide and manage the end of their lives in a manner consistent with their goals,” Cohen explains.

Cohen and colleagues conducted additional testing to determine whether patients who had completed advance care planning were really as hopeful as those who had not. “We found that level of hope was, indeed, equivalent,” Cohen reports. This does not support clinician concerns about diminishing hope by engaging in advance planning discussions. Thus, Cohen suggests providers engage in these delicate-but-important conversations with their patients.


  1. Cohen MG, Althouse AD, Arnold RM, et al. Is advance care planning associated with decreased hope in advanced cancer? JCO Oncol Pract 2020; Jun 12.