Factors Affecting Decisions Regarding Terminal Care Locations of Patients With Metastatic Breast Cancer

2020 ◽  
Vol 37 (10) ◽  
pp. 853-858
Author(s):  
Noriko Nogami ◽  
Katsuya Nakai ◽  
Yoshiya Horimoto ◽  
Akio Mizushima ◽  
Mitsue Saito
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Metastatic Breast ◽  
Life Care ◽  
Factors Influencing ◽  
Decision Making Processes ◽  
To Receive

Background: Metastatic breast cancer (MBC) is generally incurable, but patients can survive longer than those with other cancer types. Treatment strategies for MBC are complex, and it is difficult to establish evidence of efficacy since symptoms and patient backgrounds vary markedly. Some patients struggle to decide where to receive end-of-life care, despite palliative care intervention, and some die in unexpected places. With the aim of ascertaining the best way to intervene on behalf of patients with end-stage breast cancer, we retrospectively examined interventions provided by our palliative care team. We investigated factors influencing the decision-making processes of patients with MBC regarding end-of-life care locations and where patients actually died. Methods: Clinical records of 44 patients with MBC, all Japanese women, who received palliative care interventions at our hospital, were retrospectively investigated. We examined factors, such as age, possibly impacting decision-making processes regarding the final location and actual place of death. Results: Thirty-five (80%) patients were able to decide where to receive end-of-life care, while the others were not. For these 35 patients, desired locations were the palliative care unit (77%), home palliative care (14%), and the hospital (9%). Age and recurrence-free survival (RFS) were factors influencing patients’ decision-making processes ( P = .030 and .044, respectively). Of the 35 patients, 25 (71%) were able to receive end-of-life care at their desired locations. Conclusions: Young patients and those with short RFS struggled with making decisions regarding where to receive end-of-life care. Such patients might benefit from prompt introduction of advanced care planning.

scholarly journals P333 Integration of Palliative Care for Patients with Metastatic Breast Cancer: Have We Achieved Quality End-of-Life Care?

2016 ◽  
Vol 52 (6) ◽  
pp. e152
Author(s):  
Jennifer Philip ◽  
Anna Collins ◽  
Jodie Burchell ◽  
Meinir Krishnasamy ◽  
Linda Mileshkin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Metastatic Breast Cancer ◽  
End Of Life ◽  
End Of Life Care ◽  
Metastatic Breast ◽  
Life Care

scholarly journals Decision making in the end-of-life care of patients who are terminally ill with cancer – a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers.

2021 ◽  
Author(s):  
Angela Luna-Meza ◽  
Natalia Godoy-Casasbuenas ◽  
José Andrés Calvache ◽  
Eduardo Diaz ◽  
Fritz Gempeler ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Home Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
End Of Life Decisions ◽  
Care Plans ◽  
Qualitative Descriptive ◽  
Imminent Death

Abstract Background: In Colombia, recent legislation regarding end-of-life decisions includes palliative sedation, advance directives and euthanasia. We analysed which aspects influence health professionals´ decisions regarding end-of-life medical decisions and care for cancer patients.Methods: Qualitative descriptive–exploratory study based on phenomenology using semi-structured interviews. We interviewed 28 oncologists, palliative care specialists, general practitioners and nurses from three major Colombian institutions, all involved in end-of-life care of cancer patients: Hospital Universitario San Ignacio and Instituto Nacional de Cancerología in Bogotá and Hospital Universitario San José in Popayan. Results: When making decisions regarding end-of-life care, professionals consider: 1. Patient’s clinical condition, cultural and social context, in particular treating indigenous patients requires special skills. 2. Professional conditions: training in palliative care and experience in discussing end-of-life options and fear of legal consequences. Physicians indicate that many patients deny their imminent death which hampers shared decision-making and conversations. They mention frequent unclarity regarding who initiates conversations regarding end-of-life decisions with patients and who finally takes decisions. Patients rarely initiate such conversations and the professionals normally do not patients directly for their preferences. Fear of confrontation with family members and lawsuits leads doctors to carrying out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in absence of expected benefits. The opinions regarding the acceptability of palliative sedation, euthanasia and use of medications to accelerate death without the patients´ explicit request vary greatly. 3. Conditions of the insurance system: limitations exist in the offer of oncology and palliative care services for important proportions of the Colombian population. Colombians have access to opioid medications, barriers to their application are largely in delivery by the health system, the requirement of trained personnel for intravenous administration and ambulatory and home care plans which in Colombia are rare.Conclusions: to improve end-of-life decision making, Colombian physicians and patients need to openly discuss wishes, needs and care options and prepare caregivers. Promotion of palliative care education and development of palliative care centres and home care plans is necessary to facilitate access to end-of-life care. Patients and caregivers’ perspectives are needed to complement physicians’ perceptions and practices. Key Message: The results highlight the importance of improving access to end-of-life care in Colombia, and diminish the “denial of imminent death” among patients and caregivers to facilitate end-of-life discussions and shared decisions; interventions to prepare caregivers and promote home care.

The Quality of End-of-Life Care for Women Deceased From Metastatic Breast Cancer

2021 ◽  
Vol 23 (3) ◽  
pp. 238-247
Author(s):  
Rachel L. Brazee ◽  
Bethany D. Nugent ◽  
Susan M. Sereika ◽  
Margaret Rosenzweig
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
End Of Life ◽  
End Of Life Care ◽  
Metastatic Breast ◽  
Life Care

Hospice Utilization and End-of-Life Care in Metastatic Breast Cancer Patients at a Comprehensive Cancer Center

2015 ◽  
Vol 18 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Tracey L. O'Connor ◽  
Nuttapong Ngamphaiboon ◽  
Adrienne Groman ◽  
Debra L. Luczkiewicz ◽  
Sarah M. Kuszczak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Metastatic Breast ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Life Care ◽  
Breast Cancer Patients

The economic burden of end-of-life care in metastatic breast cancer

2016 ◽  
Vol 19 (11) ◽  
pp. 1075-1080 ◽  
Author(s):  
Thomas Bramley ◽  
Vincent Antao ◽  
Orsolya Lunacsek ◽  
Kristin Hennenfent ◽  
Anthony Masaquel
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
End Of Life ◽  
Economic Burden ◽  
End Of Life Care ◽  
Metastatic Breast ◽  
Life Care

scholarly journals Factors Influencing Nurses’ Ethical Decision-Making Regarding End-of-Life Care

2014 ◽  
Vol 17 (1) ◽  
pp. 34-47 ◽  
Author(s):  
DooRee Kim ◽  
김경남 ◽  
Taewha Lee ◽  
Eun Kyoung Han ◽  
김상희
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Life Care ◽  
Factors Influencing

Recording patient preferences for end-of-life care as an incentivized quality indicator: What do general practice staff think?

2011 ◽  
Vol 26 (4) ◽  
pp. 336-341 ◽  
Author(s):  
Kerin L Hannon ◽  
Helen E Lester ◽  
Stephen M Campbell
Keyword(s):  
Palliative Care ◽  
General Practice ◽  
End Of Life ◽  
End Of Life Care ◽  
Population Level ◽  
Patient Specific ◽  
Life Care ◽  
Single Issue ◽  
Practice Staff ◽  
To Receive

Introduction: Since April 2009, indicators for the UK Quality and Outcomes Framework pilot have been developed and piloted across a nationally representative sample of practices. In October 2009 a single palliative care indicator was piloted for 6 months that looked at, ‘ the percentage of patients on the palliative care register who have a preferred place to receive end-of-life care documented in the records’. Aim: The aim of this study was to gain the views and experiences of general practice staff on whether the inclusion of a single incentivized indicator to record the preferred place to receive end-of-life care would improve the quality of palliative care. Any issues arising from its implementation in a pay-for-performance scheme were also explored. Methods: Interviews took place with 57 members of staff in 24 practices: 21 GPs, 16 practice managers, 12 nurses and eight others (mostly information technology experts). Results: The indicator was not deemed appropriate for incentivization due to concerns about incentivizing an isolated, single issue within a multi-faceted, multi-disciplinary and complex topic. Palliative care was seen to be too sensitive and patient specific to be amenable to population-level quality measurement. In implementation, the indicator would pose potential harm to patients who may be asked about their end-of-life care at an inappropriate time and by a member of staff who may not be best placed to address this sensitive topic. Conclusions: The most appropriate time to ask a patient about end-of-life care is subjective and patient specific and therefore does not lend itself to an inflexible single indicator. Focusing on one isolated question simplifies and distracts from a multi-faceted and complex issue and may lead to patient harm.

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