16 Cross-cultural acceptability of the serious illness conversation guide amongst oncology healthcare professionals in South Africa

<h3>Aim</h3> The objective of this study was 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. <h3>Background</h3> 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. <h3>Methods</h3> A mixed-methods study design using a survey and focus-group discussions (FGD) with healthcare professionals was used. Participant were asked to classify the local acceptability of each SICG prompt according to a 3-tiered system. Further survey questions assessed their practice settings, and SICG use patterns. The FGD transcripts were qualitatively analysed using both inductive and deductive thematic analysis to reflect the research question as well as emerging themes. <h3>Results</h3> Synthesized results from the survey and focus group discussions with 17 healthcare workers suggest that the majority of SICG prompts are not valid or cross-culturally acceptable in the SA 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 local belief systems and culture. Specific recommendations are made to improve the cross-cultural acceptability of the SICG in the SA setting. <h3>Unique Contribution</h3> To our knowledge no study has explored the acceptability and validity of the SICG in cancer patients in South Africa (SA). <h3>Implications</h3> The findings of this study should be used to tailor SIC training in SA HCP and to design a cross-culturally acceptable SICG for further validation in the SA patient population. This could lead to increased uptake of ACP and improve understanding of EOL care preferences for South Africans.