Introduction
Palliative care and Advance Care Planning (ACP) improve the quality of life and life satisfaction of cancer patients and their families, when provided at the appropriate time. However, gynecological cancer patients often tend to misunderstand and avoid palliative care and ACP documentation. The purpose of this study is to assess recognition and preference of palliative care and ACP in gynecologic cancer patients compared to other cancer patients.
Methods
The survey was conducted at 10 hospitals, approved by institutional review board (IRB). Those patients who visited out-patient department in the hospitals were randomly asked to participate in the survey. The informed consent form was provided to the patients to help them understand the study and before assessing whether each patient was suitable to participate in the study. The selection criteria of the study were whether the patient was 20-year-old or older, willing to participate in the study, understood the purpose of the study, and diagnosed with any type of cancer. The survey questionnaire included following contents: treatment preference according to life expectancy, needs of early palliative care, recognition and intention regarding ACP and physician orders for life-sustaining treatment (POLST) according to clinical condition. The total of 610 female cancer patients completed the questionnaire.
Results
There was no significant difference in sociodemographic characteristics between non-gynecological female cancer patients and gynecological cancer patients. Gynecological cancer patients showed slightly higher recognition of POLST and ACP compared to other cancer patients, but the difference was not statistically significant. The intention to document ACP in gynecological cancer patients was significantly lower in two cases: when they were healthy and when they were just diagnosed severe illness (p<0.05). The difference in intention to document ACP tended to reduce as the life expectancy decreased (p for trend = 0.009). Furthermore, gynecological cancer patients showed lower preference of palliative care than other cancer patients in end-of-life stage (p<0.05).
Conclusion 
This nationwide survey shows that compared to other cancer patients, gynecological cancer patients have a comparatively low preference of ACP documentation and palliative care. Understanding such characteristics of gynecologic cancer patients is necessary in order to provide the appropriate ACP consultation and palliative care at the right time.

Difference in preference of advance care planning and palliative care between gynecological cancer patients and other cancer patients