Background/Objectives: Patients with incurable cancers enrolled in early phase clinical trials often face uncertainty about prognosis, yet advance care planning (ACP) is frequently delayed. The objective of this study was to assess the documentation of ACP discussions among patients enrolled in early phase oncology trials. Methods: We conducted a retrospective review of electronic medical records for all adults enrolled in early phase clinical trials at a single Australian institution (2012–2021). Data included time from metastatic diagnosis to first ACP discussion, clinical and sociodemographic factors, triggers for discussion, and clinician specialty. Results: Among 170 patients (58% male; median age 65 years), ACP documentation was identified in 109 (64%). ACP was most often initiated within the final year of life (73.8%), with a median interval of 23.5 months from metastatic diagnosis to first documentation. Common triggers were disease progression (39.6%) and hospital admission (37.8%). Discussions were typically led by the treating oncologist or trials specialist (43%) and palliative care physician (37.8%). The most frequently documented topic was the limitations of invasive care such as intubation (60%). Conclusions: ACP documentation was present in two-thirds of patients enrolled in early phase clinical trials, typically late in the disease trajectory. Integrating structured, earlier ACP discussions into oncology pathways would improve alignment of care with patient goals and enhance end-of-life care.
**背景/目的：** 参加早期临床试验的不可治愈癌症患者常面临预后不确定性，然而预先护理计划讨论常被延迟。本研究旨在评估参加早期肿瘤学试验的患者中ACP讨论的记录情况。 **方法：** 我们对澳大利亚单一机构（2012–2021年）参加早期临床试验的所有成年患者的电子病历进行了回顾性分析。数据包括从转移性诊断到首次ACP讨论的时间、临床和社会人口学因素、讨论触发因素以及临床医生专业。 **结果：** 在170名患者（58%为男性；中位年龄65岁）中，109名（64%）患者有ACP记录。ACP最常在生命的最后一年内启动（73.8%），从转移性诊断到首次记录的中位间隔为23.5个月。常见的触发因素是疾病进展（39.6%）和住院（37.8%）。讨论通常由主治肿瘤科医生或试验专家（43%）以及姑息治疗医生（37.8%）主导。最常记录的主题是侵入性护理（如插管）的局限性（60%）。 **结论：** 参加早期临床试验的患者中有三分之二存在ACP记录，但通常发生在疾病进程晚期。将结构化、更早的ACP讨论整合到肿瘤学诊疗路径中，将有助于使护理更符合患者目标，并改善临终关怀。
肿瘤(癌症)患者之家