Evaluation of the acceptability and validity of the Serious Illness Conversation Guide in oncology patients in South Africa

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dc.contributor.advisorKrause, Stephanie
dc.contributor.authorBurger, Henriette
dc.date.accessioned2025-10-31T10:59:39Z
dc.date.available2025-10-31T10:59:39Z
dc.date.issued2025
dc.date.updated2025-10-31T10:55:08Z
dc.description.abstractBackground: Advance care planning (ACP) is the process through which a health care professional (HCP) guides a patient with a life-threatening illness to better understand their disease and to make value-concordant decisions for their future medical care including their end-of-life (EOL) care. The Serious Illness Conversation Guide (SICG, Ariadne Labs 2017) was developed and validated as a structured guide for HCPs when having ACP conversations with patients. Decision-making near the end of life is influenced by many factors including health status, socio-economic status, culture, ethnicity, and decisional control preferences. To our knowledge no study has explored the acceptability and validity of the SICG (Ariadne Labs) in cancer patients in South Africa (SA). Objectives: The aims of this study are to explore the local acceptability and validity of an internationally validated serious illness conversation guide for use in advance care planning conversations in South African patients with advanced cancer. Methods: A mixed-methods study design was used to explore the local acceptability and validity of the SICG using a survey and focus-group discussions (FGD) with healthcare professionals. In the quantitative survey each participant was asked to classify the local acceptability of each SICG prompt according to a 3-tiered system. Further survey questions assessed their practice settings, patterns of ACP, perceptions of cross-cultural acceptability of prompts, and the need for additional questions in the SICG. The FGD transcripts were qualitatively analysed using both inductive and deductive thematic analysis to reflect the research question as well as emerging themes. Results: Focus group discussions (FGD) were conducted with 17 healthcare workers during 2021. Analysis of the survey and FGD data suggests that several SICG prompt are not cross- culturally acceptable in their current state in the South African setting. Emerging factors influencing acceptability in the SA oncology context included poor illness understanding, the use of complex and incongruent language, health system limitations, the role of the family, and the role of belief systems and culture. Conclusion: The findings of this study can be used to adapt the Serious Illness Conversation Guide for the South African population to increase uptake of ACP and improve understanding of EOL care preferences for South Africans.
dc.identifier.apacitationBurger, H. (2025). <i>Evaluation of the acceptability and validity of the Serious Illness Conversation Guide in oncology patients in South Africa</i>. (). University of Cape Town ,Faculty of Health Sciences ,Division of Family Medicine. Retrieved from http://hdl.handle.net/11427/42074en_ZA
dc.identifier.chicagocitationBurger, Henriette. <i>"Evaluation of the acceptability and validity of the Serious Illness Conversation Guide in oncology patients in South Africa."</i> ., University of Cape Town ,Faculty of Health Sciences ,Division of Family Medicine, 2025. http://hdl.handle.net/11427/42074en_ZA
dc.identifier.citationBurger, H. 2025. Evaluation of the acceptability and validity of the Serious Illness Conversation Guide in oncology patients in South Africa. . University of Cape Town ,Faculty of Health Sciences ,Division of Family Medicine. http://hdl.handle.net/11427/42074en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Burger, Henriette AB - Background: Advance care planning (ACP) is the process through which a health care professional (HCP) guides a patient with a life-threatening illness to better understand their disease and to make value-concordant decisions for their future medical care including their end-of-life (EOL) care. The Serious Illness Conversation Guide (SICG, Ariadne Labs 2017) was developed and validated as a structured guide for HCPs when having ACP conversations with patients. Decision-making near the end of life is influenced by many factors including health status, socio-economic status, culture, ethnicity, and decisional control preferences. To our knowledge no study has explored the acceptability and validity of the SICG (Ariadne Labs) in cancer patients in South Africa (SA). Objectives: The aims of this study are to explore the local acceptability and validity of an internationally validated serious illness conversation guide for use in advance care planning conversations in South African patients with advanced cancer. Methods: A mixed-methods study design was used to explore the local acceptability and validity of the SICG using a survey and focus-group discussions (FGD) with healthcare professionals. In the quantitative survey each participant was asked to classify the local acceptability of each SICG prompt according to a 3-tiered system. Further survey questions assessed their practice settings, patterns of ACP, perceptions of cross-cultural acceptability of prompts, and the need for additional questions in the SICG. The FGD transcripts were qualitatively analysed using both inductive and deductive thematic analysis to reflect the research question as well as emerging themes. Results: Focus group discussions (FGD) were conducted with 17 healthcare workers during 2021. Analysis of the survey and FGD data suggests that several SICG prompt are not cross- culturally acceptable in their current state in the South African setting. Emerging factors influencing acceptability in the SA oncology context included poor illness understanding, the use of complex and incongruent language, health system limitations, the role of the family, and the role of belief systems and culture. Conclusion: The findings of this study can be used to adapt the Serious Illness Conversation Guide for the South African population to increase uptake of ACP and improve understanding of EOL care preferences for South Africans. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - Advance care planning KW - South Africa LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - Evaluation of the acceptability and validity of the Serious Illness Conversation Guide in oncology patients in South Africa TI - Evaluation of the acceptability and validity of the Serious Illness Conversation Guide in oncology patients in South Africa UR - http://hdl.handle.net/11427/42074 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/42074
dc.identifier.vancouvercitationBurger H. Evaluation of the acceptability and validity of the Serious Illness Conversation Guide in oncology patients in South Africa. []. University of Cape Town ,Faculty of Health Sciences ,Division of Family Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42074en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDivision of Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectAdvance care planning
dc.subjectSouth Africa
dc.titleEvaluation of the acceptability and validity of the Serious Illness Conversation Guide in oncology patients in South Africa
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMasters
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