Reporting and measurement of anxiety and depression outcomes in advance care planning for patients with cancer: a scoping review

Background/Objective: Advance care planning (ACP) is increasingly used in oncology and palliative care; however, evidence regarding its effects on anxiety and depression remains inconsistent. This scoping review aimed to map ACP intervention studies that reported anxiety and/or depression outcomes among adults with cancer, summarize intervention and assessment characteristics, and identify research gaps. Methods: PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP were searched from inception to April 6, 2026. Eligible studies included adults with cancer, evaluated ACP-related interventions, and reported anxiety and/or depression outcomes measured using standardized instruments. Results: Of the 1,390 records identified, 12 were included. Interventions included structured ACP conversations, mindfulness-based ACP, acceptance and commitment therapy-integrated ACP, video- or decision-aid-based ACP, family-centered ACP, and multidisciplinary team-based ACP. Outcomes were assessed using heterogeneous instruments, including the Hospital Anxiety and Depression Scale (HADS), the seven-item Generalized Anxiety Disorder scale (GAD-7), the eight-item and nine-item Patient Health Questionnaires (PHQ-8 and PHQ-9), the State subscale of the State-Trait Anxiety Inventory (STAI-S), the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), psychosocial items from the Integrated Palliative Care Outcome Scale (I-POS) psychosocial items, and the Templer Death Anxiety Scale (T-DAS). Some studies have reported significant reductions in anxiety, depression, emotional distress, and death anxiety, whereas others reported only trends or no ACP-specific effects. A few studies reported transient worsening or worsening confined to the comparison groups. Conclusion: The effects of ACP on anxiety and depression in patients with cancer remain unclear. Future research should standardize psychological outcome measures, clarify assessment timing, report baseline distress and effect estimates, and distinguish between anxiety, depression, death anxiety, state anxiety, and broader psychological distress.