Attitudes of Patients With Incurable Cancer Toward Medical Treatment in the Last Phase of Life

2005 ◽  
Vol 23 (9) ◽  
pp. 2012-2019 ◽  
Author(s):  
Elsbeth Voogt ◽  
Agnes van der Heide ◽  
Judith A.C. Rietjens ◽  
Anna F. van Leeuwen ◽  
Adriaan P. Visser ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Incurable Cancer ◽  
History Of ◽  
Advance Care ◽  
Positive Feelings ◽  
End Of Life Decision ◽  
History Of Cancer

Purpose When cancer has advanced to a stage in which cure becomes unlikely, patients may have to consider the aim of further treatment. We studied the relationship of patients' attitudes toward treatment with advance care planning and the development of these attitudes after diagnosis of incurable cancer. Patients and Methods Patients with incurable cancer were interviewed and asked to fill out a written questionnaire about their attitudes concerning life-prolonging treatment and end-of-life decision making. These questions were repeated after 6 and 12 months. Results One hundred twenty-two patients (mean age, 64 years; standard deviation, 10.5 years; 53% women) participated in the study. Patients' attitudes toward treatment could be categorized into the following three different profiles: striving for quality of life, striving for length of life, and no clear preference. Patients who were older, more tired, or had less positive feelings and patients who had more often taken initiatives to engage in advance care planning were more inclined to strive for quality of life than others. Patients with a history of cancer of less than 6 months were more inclined to prefer life prolongation than patients with a longer history of cancer. During follow-up, no changes in attitudes toward treatment were found, except for patients with a short history of cancer in whom the inclination to strive for length decreased. Conclusion Patients who appreciate advance care planning were more inclined to strive for quality of life than other patients. Shortly after the diagnosis of cancer, patients typically seem to prefer life-prolonging treatment, whereas quality of life becomes more important when death is nearing.

Making Advance Directives Visual: Introducing Young Adults to Advance Care Planning With Video-Recorded Advance Directives

2019 ◽  
Vol 25 (4) ◽  
pp. e44-e51
Author(s):  
Cameron Kiersch ◽  
Teddie Potter
Keyword(s):  
Quality Of Life ◽  
Young Adults ◽  
End Of Life ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Planning Process ◽  
Care Planning ◽  
Advance Care ◽  
Definition Of

The complexities surrounding the dying process may distort rational decision-making and impact care at the end of life. Advance care planning, which focuses on identifying the individual's definition of quality of life, holds great potential to provide clarity at the end of life. Currently, young adults are not the intended audience for advance care planning. A quality improvement project engaged 36 college-age adults in structured group advance care planning discussions and evaluated the perceived value of a self-recorded advance directive. Findings from a pre- and postintervention survey suggested that young adults welcomed a conversation about end-of-life care; they wished for more information and expressed that a video-recorded advance directive stimulated thoughts about their own definition of quality of life. Participants' improved self-perception of comfort, confidence, certainty, and knowledge regarding the advance care planning process and end-of-life care indicated young adults may be a willing and eager population for the expansion of advance care planning. In addition to directing advance care planning to a younger audience, a personal video-recorded advance directive may complement the current advance care planning process and aid individuals in defining their quality of life.

Outcomes Associated with End-of-Life Discussions (DRAFT)

2018 ◽  
Author(s):  
Masanori Mori
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advanced Cancer Patients ◽  
Advance Care ◽  
Aggressive Care

Physicians and advanced cancer patients are often reluctant to talk about death. They frequently avoid end-of-life discussions (EOLds), although such conversations are essential to initiate advance care planning. In this prospective, a longitudinal multisite cohort study of advanced cancer patients and their informal caregivers, the authors suggested cascading benefits of EOLds between patients and their physicians. In total, 123 of 332 (37.0%) patients reported having EOLds with their physicians at baseline. EOLds were not associated with higher rates of emotional distress or psychiatric disorders. Instead, after propensity-score weighted adjustment, EOLds were associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care was associated with worse patient quality of life and worse bereavement adjustment. These findings may help destigmatize EOLds and assist physicians and patients in initiating such conversations and engaging in advance care planning.

scholarly journals Symptom burden, quality of life, advance care planning and the potential value of palliative care in severely ill haemodialysis patients

2003 ◽  
Vol 18 (7) ◽  
pp. 1345-1352 ◽  
Author(s):  
S. D. Weisbord ◽  
S. S. Carmody ◽  
F. J. Bruns ◽  
A. J. Rotondi ◽  
L. M. Cohen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Advance Care Planning ◽  
Symptom Burden ◽  
Care Planning ◽  
Potential Value ◽  
Advance Care

A population-based approach to end of life care and advance care planning

2018 ◽  
Author(s):  
Muir Gray ◽  
Rammya Matthews ◽  
Keri Thomas
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Population Based ◽  
Care Planning ◽  
Life Care ◽  
The People ◽  
Advance Care

A population-based approach takes account of the needs of the people within a given population. A key aspect of this is reducing unwarranted variation and addressing both the underuse of high-value interventions and the overuse of low-value interventions. In the context of end-of-life care, high-value interventions are those that enhance quality of life. In contrast, low-value interventions are those that are futile, those that negatively impact on quality of life, and those that are not in line with the person’s wishes. Advance care planning (ACP) is a means by which a person can document their choices at the end of life; it supports person-centred care and also facilitates the redistribution of investment from low-value to high-value interventions.

Advance Care Planning

2016 ◽  
Vol 34 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Laurence Tan ◽  
Lai Kiow Sim ◽  
Lynnette Ng ◽  
Hui Jin Toh ◽  
James Alvin Low
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Advance Care Planning ◽  
Treatment Options ◽  
Group Discussion ◽  
Spiritual Needs ◽  
Care Planning ◽  
Spiritual Community ◽  
Advance Care

There has been a growing trend in addressing spiritual needs in caring for the person, especially nearing the end of one’s life. Advance care planning (ACP) facilitates understanding of preferences and explores the spiritual and existential aspects of care. This study explores the views and preferences of a group of Catholic nuns in Singapore, specifically looking at what was meaningful and valuable to them when determining treatment options at the end of life. Twenty-three nuns were purposively recruited in July 2012. A focus group discussion was conducted after administration of a questionnaire and attendance at a 1-hour talk on ACP. Slightly more than half had heard of ACP prior to the talk. The majority agreed that ACP was not against their religious beliefs” and that quality of life was important to them. The themes that emerged from this study were autonomy and freedom, spirituality and quality of life, and the meaning of ACP. The findings of this study suggested that spirituality and faith define the way the participants lived their lives, including their views and preferences on end-of-life care. Integrating spirituality into an essential domain of care will help the spiritual community honor a crucial part of end-of-life discussions and afford a greater discernment of the deep meaning that ACP holds.

scholarly journals Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study

2019 ◽  
Vol 37 (2) ◽  
pp. 88-99 ◽  
Author(s):  
Shelley A. Johns ◽  
Kathleen Beck-Coon ◽  
Patrick V. Stutz ◽  
Tasneem L. Talib ◽  
Kelly Chinh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Family Caregivers ◽  
Advance Care Planning ◽  
Family Communication ◽  
Mindfulness Training ◽  
Avoidant Coping ◽  
Care Planning ◽  
Advanced Stage ◽  
Advance Care

Background: Emotional distress often causes patients with cancer and their family caregivers (FCGs) to avoid end-of-life discussions and advance care planning (ACP), which may undermine quality of life (QoL). Most ACP interventions fail to address emotional barriers that impede timely ACP. Aim: We assessed feasibility, acceptability, and preliminary effects of a mindfulness-based intervention to facilitate ACP for adults with advanced-stage cancer and their FCGs. Design: A single-arm pilot was conducted to assess the impact of a 6-week group mindfulness intervention on ACP behaviors (patients only), QoL, family communication, avoidant coping, distress, and other outcomes from baseline (T1) to post-intervention (T2) and 1 month later (T3). Participants: Eligible patients had advanced-stage solid malignancies, limited ACP engagement, and an FCG willing to participate. Thirteen dyads (N = 26 participants) enrolled at an academic cancer center in the United States. Results: Of eligible patients, 59.1% enrolled. Attendance (70.8% across 6 sessions) and retention (84.6% for patients; 92.3% for FCGs) through T3 were acceptable. Over 90% of completers reported high intervention satisfaction. From T1 to T3, patient engagement more than doubled in each of 3 ACP behaviors assessed. Patients reported large significant decreases in distress at T2 and T3. Family caregivers reported large significant improvements in QoL and family communication at T2 and T3. Both patients and FCGs reported notable reductions in sleep disturbance and avoidant coping at T3. Conclusions: The mindfulness intervention was feasible and acceptable and supported improvements in ACP and associated outcomes for patients and FCGs. A randomized trial of mindfulness training for ACP is warranted. The study is registered at ClinicalTrials.gov with identifier NCT02367508 ( https://clinicaltrials.gov/ct2/show/NCT02367508 ).

scholarly journals Current Practice of Dutch Hospital-Based Palliative Care Teams: Advance Care Planning in Advanced Stages of Disease

2021 ◽  
Author(s):  
Iris Doorne ◽  
Dick L. Willems ◽  
Nadine Baks ◽  
Jelle Kuijper ◽  
Bianca. M. Buurman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Northwestern Part ◽  
Care Planning ◽  
Dutch Hospital ◽  
Palliative Care Teams ◽  
Advance Care

Abstract Background: Specialist palliative care teams (PCT) are consulted during hospital admission for advice on complex palliative care. These consultations need to be timely to prevent symptom burden and maintain quality of life. Insight into specialist PCTs may help improve the outcomes of palliative care. Methods: In this retrospective observational study, we analyzed qualitative and quantitative data of palliative care consultations in a six-month period in four general hospitals in the northwestern part of the Netherlands. Data were obtained from electronic medical records. Results: We extracted data from 336 consultations. The most common diagnoses were cancer (54.8%) and organ failure (26.8%). 40.2% of patients were restricted to a chair or bed and 52.3% had an estimated life expectancy of less than three months. Within two weeks after consultation, 53.2% of the patients died, and the median time until death was 11 days (range 191) after consultation. Most patients died in hospital (49.4%) but only 7.5% preferred to die in hospital. Consultations were mostly requested for advance care planning (31.6%). End-of-life preferences focused on last wishes and maintaining quality of life. Conclusion: This study shows that palliative care consultations focus on terminal care and are more crisis-oriented than prevention-oriented. Death often occurs too quickly after consultation for end-of-life preferences to be met and these preferences tend to focus on dying. Educating healthcare professionals on when to initiate palliative care would promote a more prevention-oriented approach. Factors that indicate the need for timely PCT consultation should be defined.

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