Experiences of truth disclosure in terminally ill cancer patients in palliative home care

AbstractObjective:The aim of this study was to explore the experiences and preferences of terminally ill cancer patients regarding truth telling in the communication of poor prognoses.Method:We recorded and transcribed interviews with 45 patients who knew their cancer was terminal, and analyzed their responses hermeneutically.Results:Patients identified three different modes of truth: (1) the absolute objective truth that they are dying; (2) the partial truth about their condition including some facts but not all of the details; and (3) the desired truth, originating in the patient's own beliefs about a healthy or better life. Coping strategies were related to patients’ preferred mode of truth: (1) facing the truth in order to take action; (2) facing some parts of the truth in order to maintain hope; and (3) hovering between facing and avoiding the truth. In their struggle for existential survival, patients used different coping strategies, changing from one to another depending upon the circumstances.Significance of results:Varying use of different coping strategies impacts on patient preferences concerning communication about bad news with their doctors. Truth-telling entails more than merely providing information related to the forthcoming death. It also concerns how physicians or other healthcare staff can support the patient's existential survival by fine-tuning the communication of “truth” according to the individuals’ preferences.

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When is the best time to transfer terminally ill cancer patients from hospitals to palliative hospice home care? Analysis of a questionnaire survey of 1,055 surviving families.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.34_suppl.61 ◽

2018 ◽

Vol 36 (34_suppl) ◽

pp. 61-61

Author(s):

Maria Michiko Nakajima ◽

Shuhei James Nakajima ◽

Noboru Horikoshi ◽

Akihiro Isogawa ◽

Yurin Kondo ◽

...

Keyword(s):

Home Care ◽

Cancer Patients ◽

Terminally Ill ◽

Physical Pain ◽

Palliative Home Care ◽

Terminally Ill Cancer Patients ◽

Care Givers ◽

Medical Teams ◽

B 52

61 Background: It is difficult to know when the best timing is to transfer terminally ill cancer patients from hospitals to palliative hospice home care for their quality of life to death. This study aimed to articulate the best time for medical teams working in hospitals to refer their terminally ill cancer patients to palliative home care. Methods: A statistical analysis of a survey was conducted with 1,055 surviving families whose members had died with palliative home care from 1995 to 2014. The questionnaire included the following 8 contents: 1. transfer timing from hospitalization to the home care; A. appropriate, B. too late, C. too early; and the contextual items ware, 2. peacefulness of patient at dying, 3. peacefulness of patient all through the care, 4. physical pain, 5. mental pain, 6. spiritual pain, 7. alleviation of family sufferings, 8. satisfaction of family as care-givers. The response rate is 31% (311 persons). However, we excluded responses without names on the questionnaire, of non-cancer patients, with death location out of home, and without answer to question 1, resulting in 166 responses for analysis. Results: Focusing on the question 1, number of responders are A; 113 (68%), B; 52 (31%), C; 1 (0.6%). The medians of home care days to death are A; 66, B; 23, C; analysis impossible. Comparison of respondents’ satisfaction according to number of days of palliative home care revealed that 89.4% people with two months or more before their patients’ death were satisfied (A), while 10.6% of those who had less than two month were unsatisfied (B+C). Conclusions: Most surviving families were satisfied if they had two months or more for palliative home care. This survey suggests the relevancy to start preparation for discharge that enables the patients to stay home with their family members for two months or more. [Table: see text]

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Caregiver burden and bereavement among family caregivers who lost terminally ill cancer patients

Palliative & Supportive Care ◽

10.1017/s1478951518001025 ◽

2019 ◽

Vol 17 (5) ◽

pp. 515-522

Author(s):

Yong Tang

Keyword(s):

Content Analysis ◽

Cancer Patients ◽

Family Caregivers ◽

Caregiver Burden ◽

Hospice Care ◽

Southern China ◽

Terminally Ill ◽

Truth Telling ◽

Terminally Ill Cancer Patients ◽

Attitudes Toward Death

AbstractObjectiveFamily caregivers (FCs) in China provide hospice care to terminally ill cancer patients; however, few studies have been conducted in China on caregiver burden and bereavement experiences as a process that continues over time. The purpose of this study was to identify the main elements of caring and bereavement experiences for FCs caring for patients diagnosed with terminal cancer.MethodTwenty in-depth qualitative semistructured interviews were conducted with FCs providing care in a hospice unit in Shenzhen, Southern China. Interview transcripts were analyzed via thematic content analysis.ResultA framework based on the following eight principal themes was developed through content analysis of our FC interviews: symptoms of the illness, the truth-telling process, attitudes toward death, the “color” of death, social and professional support, the moment of death, and grief and loss.Significance of resultsThe analysis showed that caregiving may positively or negatively influence the bereavement process.

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Factors influencing truth-telling by healthcare providers to terminally ill cancer patients at Ocean Road Cancer Institute in Dar-es-Salaam, Tanzania

South African Journal of Bioethics and Law ◽

10.7196/sajbl.2020.v13i2.00706 ◽

2020 ◽

Vol 13 (2) ◽

pp. 108

Author(s):

R Athanas ◽

F Gasto ◽

S J Renatha

Keyword(s):

Cancer Patients ◽

Healthcare Providers ◽

Terminally Ill ◽

Dar Es Salaam ◽

Truth Telling ◽

Terminally Ill Cancer Patients ◽

Factors Influencing

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Coping strategies employed by informal carers of terminally ill cancer patients

Journal of Cancer Nursing ◽

10.1016/s1364-9825(97)80072-7 ◽

1997 ◽

Vol 1 (3) ◽

pp. 126-133 ◽

Cited By ~ 20

Author(s):

Karen E Rose ◽

Christine Webb ◽

Karen Waters

Keyword(s):

Coping Strategies ◽

Cancer Patients ◽

Terminally Ill ◽

Terminally Ill Cancer Patients ◽

Informal Carers

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Palliative home care unit (PHCU). Project of care of terminally ill cancer patients in their homes

European Journal of Cancer ◽

10.1016/s0959-8049(97)86277-6 ◽

1997 ◽

Vol 33 ◽

pp. S304

Author(s):

S. Capra ◽

L. Montanan ◽

C. Assirelli ◽

V. Salemo ◽

M.R.A. Gentili ◽

...

Keyword(s):

Home Care ◽

Cancer Patients ◽

Terminally Ill ◽

Palliative Home Care ◽

Terminally Ill Cancer Patients

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Predictive Factors for the Development of Dyspnea Within 7 Days After Admission Among Terminally Ill Cancer Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211028817 ◽

2021 ◽

pp. 104990912110288

Author(s):

Ryo Matsunuma ◽

Takashi Yamaguchi ◽

Masanori Mori ◽

Tomoo Ikari ◽

Kozue Suzuki ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Predictive Factors ◽

Performance Status ◽

Univariate Analysis ◽

Terminally Ill ◽

Primary Lung Cancer ◽

Poor Performance Status ◽

Terminally Ill Cancer Patients ◽

Development Group

Background: Predictive factors for the development of dyspnea have not been reported among terminally ill cancer patients. Objective: This current study aimed to identify the predictive factors attributed to the development of dyspnea within 7 days after admission among patients with cancer. Methods: This was a secondary analysis of a multicenter prospective observational study on the dying process among patients admitted in inpatient hospices/palliative care units. Patients were divided into 2 groups: those who developed dyspnea (development group) and those who did not (non-development group). To determine independent predictive factors, univariate and multivariate analyses using the logistic regression model were performed. Results: From January 2017 to December 2017, 1159 patients were included in this analysis. Univariate analysis showed that male participants, those with primary lung cancer, ascites, and Karnofsky Performance Status score (KPS) of ≤40, smokers, and benzodiazepine users were significantly higher in the development group. Multivariate analysis revealed that primary lung cancer (odds ratio [OR]: 2.80, 95% confidence interval [95% CI]: 1.47-5.31; p = 0.002), KPS score (≤40) (OR: 1.84, 95% CI: 1.02-3.31; p = 0.044), and presence of ascites (OR: 2.34, 95% CI: 1.36-4.02; p = 0.002) were independent predictive factors for the development of dyspnea. Conclusions: Lung cancer, poor performance status, and ascites may be predictive factors for the development of dyspnea among terminally ill cancer patients. However, further studies should be performed to validate these findings.

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To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients

BMC Palliative Care ◽

10.1186/s12904-021-00710-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Chien-Yi Wu ◽

Ping-Jen Chen ◽

Tzu-Lin Ho ◽

Wen-Yuan Lin ◽

Shao-Yi Cheng

Keyword(s):

Cancer Patients ◽

Proportional Hazards Model ◽

Clinical Symptoms ◽

Terminally Ill ◽

Good Death ◽

Artificial Nutrition ◽

Symptom Improvement ◽

Terminally Ill Cancer Patients ◽

Quality Of Dying

Abstract Background Artificial nutrition and hydration do not prolong survival or improve clinical symptoms of terminally ill cancer patients. Nonetheless, little is known about the effect of artificial hydration (AH) alone on patients’ survival, symptoms or quality of dying. This study explored the relationship between AH and survival, symptoms and quality of dying among terminally ill cancer patients. Methods A pilot prospective, observational study was conducted in the palliative care units of three tertiary hospitals in Taiwan between October 2016 and December 2017. A total of 100 patients were included and classified into the hydration and non-hydration group using 400 mL of fluid per day as the cut-off point. The quality of dying was measured by the Good Death Scale (GDS). Multivariate analyses using Cox’s proportional hazards model were used to assess the survival status of patients, the Wilcoxon rank-sum test for within-group analyses and the Mann-Whitney U test for between-groups analyses to evaluate changes in symptoms between day 0 and 7 in both groups. Logistic regression analysis was used to assess the predictors of a good death. Results There were no differences in survival (p = 0.337) or symptom improvement between the hydration and non-hydration group, however, patients with AH had higher GDS scores. Conclusions AH did not prolong survival nor significantly improve dehydration symptoms of terminally ill cancer patients but it may influence the quality of dying. Communication with patients and their families on the effect of AH may help them better prepared for the end-of-life experience.

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