{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:02:44Z","timestamp":1782964964547,"version":"3.54.5"},"reference-count":34,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"unspecified","delay-in-days":36,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951526101655_sec1a\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore cancer patients\u2019 understanding of Advance Care Planning (ACP) and identify the main barriers hindering its effective implementation in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526101655_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative descriptive study included Brazilian women with breast cancer aged 18\u201375 years, all with preserved functional status, recruited by convenience sampling. Exclusion criteria were difficulty using online calls or significant communication impairment. Data collection involved a sociodemographic questionnaire and a follow-up interview. After receiving an informational brochure, participants were contacted by video call 14 days later and asked, \u201cHow do you understand what ACP is?\u201d Interviews were conducted confidentially at home, transcribed, and analyzed according to qualitative research reporting guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526101655_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-one women participated. Most had difficulty understanding ACP; nearly 40% could not define it. Main barriers included cultural resistance to discussing death, reliance on family members or physicians for decision-making, and lack of clear information. Many participants confused ACP with preventive care. A conceptual multilevel model was developed, showing how cultural taboos, family dependence, and systemic inertia interact to sustain barriers through a feedback loop in which cultural avoidance reinforces structural gaps and institutional neglect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526101655_sec4d\">\n                    <jats:title>Significance of results<\/jats:title>\n                    <jats:p>This study provides evidence on how ACP is understood and misinterpreted by cancer patients in a middle-income Latin American setting, an area that remains underrepresented in the literature. By demonstrating that misconceptions, cultural taboos, and systemic barriers operate through a reinforcing multilevel process, the findings offer a conceptual framework that explains why ACP remains marginal in routine oncology care. The model highlights critical points for intervention, including patient education, professional communication, and institutional support, and is directly applicable to similar sociocultural contexts characterized by strong family involvement and biomedical dominance. These results have clear implications, supporting the integration of ACP as a proactive, relational, and value-based process rather than a late end-of-life intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951526101655","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:49:34Z","timestamp":1770374974000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Understanding Advance Care Planning in oncology: Barriers, perceptions, and pathways toward patient-centered decision-making"],"prefix":"10.1017","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8906-868X","authenticated-orcid":false,"given":"Fulvio Bergamo","family":"Trevizan","sequence":"first","affiliation":[{"name":"Barretos Cancer Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7934-1451","authenticated-orcid":false,"given":"Carlos Eduardo","family":"Paiva","sequence":"additional","affiliation":[{"name":"Barretos Cancer Hospital"},{"name":"Institute of Education and Research, Barretos Cancer Hospital"},{"name":"Barretos Cancer Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5052-1846","authenticated-orcid":false,"given":"Livia Costa","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Barretos Cancer Hospital"},{"name":"National Cancer Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karla Santos","family":"da Costa Rosa","sequence":"additional","affiliation":[{"name":"Barretos Cancer Hospital"},{"name":"National Cancer Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2711-8346","authenticated-orcid":false,"given":"Bianca Sakamoto Ribeiro","family":"Paiva","sequence":"additional","affiliation":[{"name":"Barretos Cancer Hospital"},{"name":"Institute of Education and Research, Barretos Cancer Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"S1478951526101655_ref8","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-022-01052-w"},{"key":"S1478951526101655_ref19","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.17611"},{"key":"S1478951526101655_ref28","doi-asserted-by":"publisher","DOI":"10.1177\/0825859720938583"},{"key":"S1478951526101655_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.zefq.2023.04.010"},{"key":"S1478951526101655_ref13","first-page":"e0301426","article-title":"Advance care planning as perceived by marginalized populations: willing to engage and facing obstacles","volume":"19","author":"Izumi","year":"2024","journal-title":"Public Library of Science 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and Advance Care Planning in Cancer","volume":"16","author":"Faiman","year":"2025","journal-title":"Journal of the Advanced Practitioner in Oncology"},{"key":"S1478951526101655_ref32","doi-asserted-by":"publisher","DOI":"10.1177\/0269216313486953"},{"key":"S1478951526101655_ref11","first-page":"70","article-title":"End-of-life preparedness and quality of advance care planning discussions in patients with advanced metastatic cancer","volume":"52","author":"Goswami","year":"2024","journal-title":"Oncology Nursing Forum"},{"key":"S1478951526101655_ref2","article-title":"Planificaci\u00f3n avanzada de cuidados en personas con c\u00e1ncer avanzado: un estudio fenomenol\u00f3gico","volume":"16","author":"Arias-Rojas","year":"2025a","journal-title":"Revista 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and Supportive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1478951526101655","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:49:35Z","timestamp":1770374975000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1478951526101655\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":34,"alternative-id":["S1478951526101655"],"URL":"https:\/\/doi.org\/10.1017\/s1478951526101655","relation":{},"ISSN":["1478-9515","1478-9523"],"issn-type":[{"value":"1478-9515","type":"print"},{"value":"1478-9523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e54"}}