Analysis of the speech of dying patients with cancer on end-of-life decision making

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 8216-8216
Author(s):  
I. N. Olver ◽  
J. A. Eliott
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Patients With Cancer ◽  
Dying Patients ◽  
End Of Life Decision ◽  
Life Decision

scholarly journals Use of Video to Facilitate End-of-Life Discussions With Patients With Cancer: A Randomized Controlled Trial

2010 ◽  
Vol 28 (2) ◽  
pp. 305-310 ◽  
Author(s):  
Areej El-Jawahri ◽  
Lisa M. Podgurski ◽  
April F. Eichler ◽  
Scott R. Plotkin ◽  
Jennifer S. Temel ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Controlled Trial ◽  
Verbal Description ◽  
Comfort Care ◽  
Goals Of Care ◽  
Patients With Cancer ◽  
Basic Care ◽  
End Of Life Decision ◽  
Life Decision

Purpose To determine whether the use of a goals-of-care video to supplement a verbal description can improve end-of-life decision making for patients with cancer. Methods Fifty participants with malignant glioma were randomly assigned to either a verbal narrative of goals-of-care options at the end of life (control), or a video after the same verbal narrative (intervention) in this randomized controlled trial. The video depicts three levels of medical care: life-prolonging care (cardiopulmonary resuscitation [CPR], ventilation), basic care (hospitalization, no CPR), and comfort care (symptom relief). The primary study outcome was participants' preferences for end-of-life care. The secondary outcome was participants' uncertainty regarding decision making (score range, 3 to 15; higher score indicating less uncertainty). Participants' comfort level with the video was also measured. Results Fifty participants were randomly assigned to either the verbal narrative (n = 27) or video (n = 23). After the verbal description, 25.9% of participants preferred life-prolonging care, 51.9% basic care, and 22.2% comfort care. In the video arm, no participants preferred life-prolonging care, 4.4% preferred basic care, 91.3% preferred comfort care, and 4.4% were uncertain (P < .0001). The mean uncertainty score was higher in the video group than in the verbal group (13.7 v 11.5, respectively; P < .002). In the intervention arm, 82.6% of participants reported being very comfortable watching the video. Conclusion Compared with participants who only heard a verbal description, participants who viewed a goals-of-care video were more likely to prefer comfort care and avoid CPR, and were more certain of their end-of-life decision making. Participants reported feeling comfortable watching the video.

Trends in End-of-Life Decision Making in Patients With and Without Cancer

2013 ◽  
Vol 31 (11) ◽  
pp. 1450-1457 ◽  
Author(s):  
Koen Pardon ◽  
Kenneth Chambaere ◽  
H. Roeline W. Pasman ◽  
Reginald Deschepper ◽  
Judith Rietjens ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Death Certificate ◽  
Symptom Burden ◽  
End Of Life Decisions ◽  
Patients With Cancer ◽  
Symptom Alleviation ◽  
End Of Life Decision ◽  
Explicit Request ◽  
Life Decision

Purpose Because of cancer's high symptom burden and specific disease course, patients with cancer are more likely than other patients to face end-of-life decisions that have possible or certain life-shortening effects (ELDs). This study examines the incidence of ELDs in patients with cancer compared with patients without cancer and the trends in ELD incidence from 1998-2007. Patients and Methods A nationwide death certificate study in Flanders, Belgium, was conducted in 2007, analogous to one completed in 1998. Physicians who had signed selected death certificates (n = 6,927) were sent a questionnaire. Results The response rate was 58.4%. Nonsudden deaths were studied. Intensified symptom alleviation occurred more in patients with cancer than in those without (53.8% v 31.7%; P < .001) as did euthanasia (6.8% v 0.9%; P < .001). There was no difference between groups in nontreatment decisions and life-ending acts without patient's explicit request. Patients with cancer were less involved in the end-of-life decision-making process than patients without cancer (69.7% v 83.5%; P = .001). From 1998 to 2007, ELD incidence has increased in patients with cancer (+6.7%) and even more in patients without cancer (+14.9%) because of an increase in intensified symptom alleviation. In patients with cancer, euthanasia rates increased strongly and life-ending acts without the patient's explicit request decreased. Conclusion The higher ELD incidence in patients with cancer compared with those without is probably related to differences in disease trajectories and access to end-of-life care. During the period from 1998 to 2007, when euthanasia was legalized and palliative care intensified, overall ELDs increased, including those as a result of symptom alleviation and euthanasia, with a decrease in life-ending acts without explicit request.

The meanings of “hope” to patients with cancer, nearing the end of their lives

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18567-18567
Author(s):  
I. N. Olver ◽  
J. A. Eliott
Keyword(s):  
Decision Making ◽  
Discourse Analysis ◽  
Sample Size ◽  
End Of Life ◽  
Structured Interviews ◽  
Patients With Cancer ◽  
Life Lessons ◽  
Data Saturation ◽  
End Of Life Decision ◽  
Life Decision

18567 Background: In two studies of the speech of patients with cancer about end-of-life decision-making, the word hope was often spontaneously used. In 23 patients earlier in their disease there was a difference between hope used as a noun, often objective, outside the patient’s control, and presented as “no hope”, or as a verb which was directed by patients and facilitated imagining a positive future (Qual Health Res 2002, 12: 173–193). In a second study 28 patients judged within 3 months of dying, following unprompted use of hope during interview, were specifically prompted to talk about hope. Methods: Discourse analysis was used to analyze the speech from the semi-structured interviews of the patients. The sample size was determined by data saturation. Results: All in the second study were Caucasian, average age 61, 15 males, 18 had partners and 19 were Christian, 1 Druid, and 8 listing no religion. Ten patients made reference to hope as variable in amount. In general the more the better, but even 1%, while trivial scientifically, may be important personally. The problem with quantifiable hope is that it is perceived to dwindle with the medical prognosis with which “no hope” is most often identified. Twenty patients hoped for a longer life although 19 had specifically indicated that they were dying, suggesting that this hope was not death denying. Most wanted more time to achieve tasks and be with family. Hoping recognized uncertainty yet attested to the value patients placed on various activities. Eight talked of hoping for a cure, although this was not overwhelming in the present. Some mentioned the possibility of a miracle cure, reinforced by the construction that medicine gives hope. Hope sometimes shifted from life to either an acceptable dying in 8 patients or to focus on others. The legacy to others could be objects or life lessons. Hopes can be shared by partners and can change. Two patients spoke of hope sourced from God and as enduring beyond death. Conclusions: Patients found it challenging to talk of hope in the abstract. Hope can be positive and sustaining or disillusioning when not attained. No significant financial relationships to disclose.

End-of-Life Decision-Making in Canada: The Report by the Royal Society of Canada Expert Panel on End-of-Life Decision-Making

2011 ◽  
Author(s):  
Udo Schuklenk ◽  
Johannes J. M. van Delden ◽  
Jocelyn Downie ◽  
Sheila McLean ◽  
Ross Upshur ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Royal Society ◽  
Expert Panel ◽  
End Of Life Decision ◽  
Life Decision

scholarly journals “What Would You Do?”: How Cat Owners Make End-of-Life Decisions and Implications for Veterinary-Client Interactions

Animals ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 1114
Author(s):  
Katherine Littlewood ◽  
Ngaio Beausoleil ◽  
Kevin Stafford ◽  
Christine Stephens
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
End Of Life ◽  
Companion Animals ◽  
Chronically Ill ◽  
Future Research ◽  
End Of Life Decisions ◽  
Life Decisions ◽  
End Of Life Decision ◽  
Life Decision

Cats are the most common companion animals in New Zealand. Advances in veterinary care means that cats are living longer and there are many older cats. End-of-life decisions about cats are complicated by owner–cat relationships and other psychosocial factors. Our study explored the ways in which end-of-life decisions were being made by owners of older and chronically ill cats in New Zealand and the role of their veterinarian in the process. Qualitative data were gathered via retrospective semi-structured interviews with 14 cat owners using open-ended questions. Transcripts of these interviews were explored for themes using template analysis and nine themes were identified. Four were animal-centered themes: cat behavior change, pain was a bad sign, signs of ageing are not good, and the benefits of having other people see what owners often could not. Five were human-centered themes: veterinarians understanding owners’ relationships with their cat, normalizing death, the need for a good veterinarian to manage end of life, veterinary validation that owners were doing the right thing, and a strong desire to predict the time course and outcome for their cat. End-of-life decision making is complex, and the veterinarian’s role is often poorly defined. Our owners appreciated the expertise and validation that their veterinarian provided but continuity of care was important. Future research aimed at exploring the veterinarian’s perspective during end-of-life decision making for cats would be a valuable addition to the topic.

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