Deciding to withhold or withdraw (WH/WD) anticancer therapy (ACT) in advanced cancer patients: Physicians and patients points of view and interactions.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19623-e19623
Author(s):  
Yvan Beaussant ◽  
Christophe Tournigand ◽  
Lionel Pazart ◽  
Florence Mathieu-Nicot ◽  
Elodie Cretin ◽  
...  
Keyword(s):  
Decision Making ◽  
Advanced Cancer ◽  
Treatment Options ◽  
Epidemiological Survey ◽  
Physician Patient Relationship ◽  
Advanced Cancer Patients ◽  
Difficult Decision ◽  
Benefit Risk Assessment ◽  
Points Of View ◽  
Physician Patient

e19623 Background: ASCO highlighted the need to improve communication with and decision making for pts with advanced cancer. This study explores the decision-making process for pts with advanced cancer when the question to WH/WD ACT is raised, with a cross-analysis of physicians and pts points of view. Methods: Multi-center qualitative study in 5 oncology and hematology units, based on semi-structured single interviews with referent oncologists and their pts. An epidemiological survey was performed to identify the prevalence of such decisions. Results: Of the 839 pts hospitalized during a given week, the question to WH/WD ACT was raised in 3.4% of cases (n=29) and in 12,8% when excluding ambulatory pts (n=26 of 202). All 29 referent physicians and 21 pts were interviewed. Futility and poor general condition were the most frequently cited reasons to WH/WD ACT. Subjective determinants related to the physician/patient relationship and their respective experiences were also predominant in all interviews. Although most physicians reported attempting to fully inform pts about their poor prognosis and treatment options, only a minority were able to anticipate the option to WH/WD ACT in these discussions. The fear to remove pts’ hope and to increase anxiety, and a feeling of capitulation and abandonment were the main obstacles they pointed out. For pts, hope and struggle attitudes were predominant, as well as anxiety about their situation and confidence in the physicians’ decisions. More than 80% of pts declared leaving the physician to decide alone. Most of them expected to be involved in the decisions, but only 1/3 reported being actually aware of this questioning. Conclusions: In this study, oncologists faced the difficult decision whether to continue, WH/WD ACT for 1/7 hospitalized patient. The uncertainty of the benefit/risk assessment seemed to strengthen the subjective determinants of the questioning. Pts and physicians mutual willingness to maintain hope reinforced an attitude of “not giving up”. Communication training of health professionals and integrative palliative care could favor the ethical questioning and improve care through the respect of pts’ preferences.

Decision making for older adults with advanced cancer: Patient and family member perspectives.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 101-101 ◽  
Author(s):  
Susan Elizabeth Hickman ◽  
Michael T. Weaver ◽  
Barbara Habermann ◽  
Paul R. Helft
Keyword(s):  
Decision Making ◽  
Family Member ◽  
Advanced Cancer ◽  
Treatment Options ◽  
Family Members ◽  
Current Treatment ◽  
Advanced Cancer Patients ◽  
Goals Of Care ◽  
Metastatic Lung ◽  
Communication Conflict

101 Background: The National Cancer Institute and palliative care guidelines emphasize the importance of family member perspectives in end-of-life decision-making for patients with advanced cancer. However, only a handful of studies have examined what role family members play in decisions to continue or discontinue disease-directed therapy. Methods: Thirty-four dyads consisting of a patient (PT) aged 65 and older with metastatic lung, pancreatic, or esophageal cancer and a family member (FM) filled out surveys about goals of care, discussions with the treating oncologist, communication conflict, and decisional uncertainty. Results: Most PTs (60%) understood their cancer was metastatic, and 86% reported they were currently receiving chemotherapy. PTs and FMs (82%) had a shared understanding about current goal of treatment and were more likely to report discussions with the treating oncologist about reasons to continue chemotherapy (90%) than discussions about reasons to discontinue it (53%) (McNemar’s S = 7.0, DF = 1, exact p =.016). However, only a minority of PTs and FMs (26.5%) agree on the preferred course of treatment. FMs (59%) were more likely than PTs (24%) to prefer a course of treatment focused on palliation rather than extending life (Bowker’s S=9.3, DF=3, p=.026). Many patients (44%) were unsure of their preferences. Patients who perceived higher levels of communication conflict with their family reported more decisional uncertainty about their preferred treatment option (r =.49, p =.02). Conclusions: Patients and family members largely share in their understanding of the current treatment goal and recall of discussions with the oncologist about treatment options. However, family members tend to prefer a course of treatment focused on comfort compared to patients, who prefer a course of treatment that extends life as much as possible even if it means having more side effects, pain, or discomfort. Patients who report conflicted communication with family members are more uncertain about their decisions. Findings suggest a need for increased discussion about goals of care and treatment alternatives with advanced cancer patients and their family members.

Prudence in Shared Decision-Making: The Missing Link between the “Technically Correct” and the “Morally Good” in Medical Decision-Making

2020 ◽  
Author(s):  
Paul Muleli Kioko ◽  
Pablo Requena Meana
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Intellectual Ability ◽  
Medical Decision ◽  
Shared Decision ◽  
Physician Patient Relationship ◽  
Good Healing ◽  
The Right ◽  
Physician Patient

Abstract Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be.

scholarly journals Practical considerations in the use of regorafenib in metastatic colorectal cancer

2020 ◽  
Vol 12 ◽  
pp. 175883592095686
Author(s):  
Fotios Loupakis ◽  
Lorenzo Antonuzzo ◽  
Jean-Baptiste Bachet ◽  
Feng-Che Kuan ◽  
Teresa Macarulla ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Metastatic Colorectal Cancer ◽  
Treatment Options ◽  
Daily Practice ◽  
The Third ◽  
Appropriate Treatment ◽  
Third Line ◽  
Line Setting ◽  
Physician Patient

Over the past 20 years, management of patients with metastatic colorectal cancer (mCRC) has improved considerably, leading to increased overall survival and more patients eligible for third- or later-line therapy. Currently, two oral therapies are recommended in the third-line treatment of mCRC, regorafenib and trifluridine/tipiracil. Selecting the most appropriate treatment in the third-line setting poses different challenges compared with treatment selection at earlier stages. Therefore, it is important for physicians to understand and differentiate between available treatment options and to communicate the benefits and challenges of these to patients. In this narrative review, practical information on regorafenib is provided to aid physicians in their decision-making and patient communications in daily practice. We discuss the importance of appropriate patient selection and adverse events management through close patient monitoring and dose adjustments to ensure patients stay on treatment for longer and receive as much benefit as possible. We also highlight key physician–patient communication points to facilitate shared decision-making.

Supporting Treatment Decision Making in Advanced Cancer: A Randomized Trial of a Decision Aid for Patients With Advanced Colorectal Cancer Considering Chemotherapy

2011 ◽  
Vol 29 (15) ◽  
pp. 2077-2084 ◽  
Author(s):  
Natasha B. Leighl ◽  
Heather L. Shepherd ◽  
Phyllis N. Butow ◽  
Stephen J. Clarke ◽  
Margaret McJannett ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Randomized Trial ◽  
Advanced Cancer ◽  
Decision Aid ◽  
Advanced Colorectal Cancer ◽  
Treatment Options ◽  
Decisional Conflict ◽  
First Line ◽  
Line Chemotherapy

Purpose Decision making in advanced cancer is increasingly complex. We developed a decision aid (DA) for patients with advanced colorectal cancer who are considering first-line chemotherapy and reviewing treatment options, prognostic information, and toxicities. We examined its impact on patient understanding, treatment decisions, decisional conflict, decision making, consultation satisfaction, anxiety, and quality of life by using a randomized trial design. Patients and Methods In all, 207 patients with colorectal cancer who were considering first-line chemotherapy for metastatic disease were randomly assigned to receive a standard medical oncology consultation or a consultation in which the DA (take-home booklet with audio recording, reviewed by an oncologist) was used. Participants completed questionnaires postconsultation, postdecision, and 1 month later. Results In this study, 100 patients were randomly assigned to the control arm, and 107 received the DA. Median age of the sample was 62 years, 58% were male, 89% had a performance status of 0 or 1, and 36% had received prior adjuvant chemotherapy. Patients receiving the DA demonstrated a greater increase in understanding of prognosis, options, and benefits, with higher overall understanding (P < .001). Decisional conflict, treatment decisions, and achievement of involvement preferences were similar between the groups. Anxiety was similar across groups and decreased over time. Most patients were confident in a decision during the first consultation; 74% chose chemotherapy, 7% supportive care alone, and 10% observation. Conclusion This randomized trial of a decision aid in advanced cancer showed that its use in advanced colorectal cancer improved patient understanding of prognosis, treatment options, risks, and benefits without increasing anxiety. DAs can improve informed consent and can be tested through randomized trials even in the advanced cancer setting.

Physician Message and Patient’s Perception of Compassion (DRAFT)

2018 ◽  
Author(s):  
Lynn A. Flint ◽  
Eric Widera
Keyword(s):  
Cancer Treatment ◽  
Crossover Study ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Clinical Case ◽  
Treatment Options ◽  
The Other ◽  
Advanced Cancer Patients ◽  
Patient’S Perception ◽  
Randomized Crossover Study

This randomized, crossover study examined advanced cancer patients’ perceptions of physician compassion when delivering a less optimistic versus more optimistic message. Patients with advanced cancer viewed two videos, each depicting actors portraying a physician and a patient discussing cancer treatment options. In one video, the physician delivers a less optimistic message and in the other, the physician delivers a more optimistic message. Participants rated their perceptions of physician compassion after viewing each video. They perceived the physician with the more optimistic message as more compassionate than the physician with the less optimistic message. The chapter describes the basics of the study, briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Experiences and hidden needs of older patients, their families and their physicians in palliative chemotherapy decision-making: a qualitative study

2020 ◽  
Vol 50 (7) ◽  
pp. 779-786 ◽  
Author(s):  
Rie Tsuboi ◽  
Mihoko Sugishita ◽  
Yoshihisa Hirakawa ◽  
Yuichi Ando
Keyword(s):  
Decision Making ◽  
Advanced Cancer ◽  
Older Patients ◽  
Palliative Chemotherapy ◽  
Treatment Options ◽  
Spiritual Needs ◽  
Evidence Based ◽  
Psychological Issues ◽  
Individual Interviews ◽  
To Receive

Abstract Objective This study aimed to clarify the experiences and hidden needs of older patients with advanced cancer, their families and their physicians in palliative chemotherapy decision-making. Materials and Methods We conducted in-depth qualitative individual interviews with content analysis. Patients who were diagnosed as having advanced cancer, were aged ≥70 years (n = 15, median [range] = 77 [70–82] years) and had volunteered to receive palliative chemotherapy within the past 6 months were enrolled. Their families and physicians were also interviewed. Results The following four themes were identified: (i) physician’s awareness of paternalism; (ii) readiness for communication of serious news; (iii) spiritual care need assessment and (iv) support as a team. The patients and families expected physicians to demonstrate paternalism in their decision-making because they were unconfident about their self-determination capability. Although the physicians were aware of this expectation, they encountered difficulties in recommending treatment and communicating with older patients. The patients had spiritual pain since the time of diagnosis. Psychological issues were rarely discussed during decision-making and treatment, triggering feelings of isolation in the patients and their families. Conclusion Older patients and their families expected a paternalistic approach by the physicians for palliative chemotherapy decision-making. The physicians found it difficult to offer treatment options because of older patient diversity and limitations in evidence-based strategies. Therefore multidisciplinary approaches and evidence-based decision support aids are warranted. Because older patients and their families often have unexpressed psychological burdens including unmet spiritual needs, medical professionals should provide psychological care from the time of diagnosis.

scholarly journals The Roles of Health Literacy and Physician-Patient Relationship in Self-Reported Health Outcomes Within a Diverse Sample of Persons Living with HIV

2019 ◽  
Vol 34 (7) ◽  
pp. 1273-1273
Author(s):  
E Santana ◽  
J Gonzalez ◽  
D Byrd ◽  
M Rivera Mindt
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Health Literacy ◽  
Health Outcomes ◽  
Physical Functioning ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Persons Living With Hiv ◽  
Living With Hiv ◽  
Physician Patient

Abstract Objective Barriers like poor health literacy and patient-provider communication add to health disparities in diverse populations. Perceived autonomy has been shown to improve patients’ health satisfaction and knowledge of their illness. However, no studies have examined these issues in HIV patients. This study examined the roles of health literacy and physician-patient relationship in health outcomes (e.g., mental health and emotional/physical functioning) in persons living with HIV (PLWH). Participants and Method This cross-sectional study included 91 PLWH (74% Latinx and 26% non-Latinx White; 68% Male) who completed the Test of Functional Health Literacy in Adults (TOFHLA), Physician–Patient Relationship Scale (PPRS), and Medical Outcomes Study-HIV Health Survey (MOS). The study variables included: TOFHLA total score, PPRS Part Decision- Making (PDM) and Trust subscales, and MOS Mental Health and Health Transition subscales. Results A linear regression showed that our model (ethnicity, TOFHLA, PPRS PDM and Trust) predicted MOS HT (R2 = .14, p &lt; 0.05), such that Latinx ethnicity (β = .30) and better TOFHLA scores (β = -.22) predicted better MOS HT scores (ps &lt; .05). Another regression showed that our model predicted MOS MH (R2 = 0.07, p = &lt;.01), such that greater PPRS PDM scores predicted better MOS MH scores (β = .27, p = &lt;.01). Conclusions Ethnicity and better health literacy were related to improved emotional/physical functioning over a 4-week period and greater shared decision-making was related to better overall mental health. These findings highlight the importance of identifying sociocultural factors and interpersonal processes of care to inform culturally-tailored interventions that can result in enhanced and effective treatment for PLWH patients and in improved physical and mental health outcomes.

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