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.

scholarly journals Chinese Physicians’ Perceptions of Palliative Care Decision-making for Advanced Cancer Patients: A Qualitative Analysis at a Tertiary Hospital in Changsha, China

2021 ◽  
Author(s):  
Jessica Hahne ◽  
Xiaomin Wang ◽  
Rui Liu ◽  
Yuqiong Zhong ◽  
Xin Chen ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Medical Training ◽  
Family Members ◽  
Tertiary Hospital ◽  
Advanced Cancer Patients ◽  
Care Access ◽  
Care Decision

Abstract Background: Little previous research has been conducted outside of major cities in China to examine how physicians currently perceive palliative care, and to identify specific goals for training as palliative care access expands. This study explored physicians’ perceptions of palliative care decision-making for advanced cancer patients in Changsha, China.Methods: We conducted semi-structured qualitative interviews with physicians (n=24) specializing in hematology or oncology at a tertiary hospital. Results: Most physicians viewed palliative care as equivalent to end-of-life care, while a minority considered it possible to integrate palliative care with active treatment. Almost all physicians maintained separate conversations about palliative care with family members and patients, communicating more directly with family members than with patients about palliative care decisions. Physicians described experiencing ethical tension between the desire of family members to protect the patient from knowing they have advanced cancer, and the patient’s “right to decide” about palliative treatment. Physicians varied overall regarding perceptions of the role they should have in palliative care decision-making.Conclusions: As palliative care access expands in China, medical training should encourage earlier integration of palliative care for advanced cancer, address ethical issues faced by physicians communicating about palliative care, and establish guidance on the role of the physician in palliative care decision-making.

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.

Wernicke encephalopathy in a caregiver: A serious physical issue resulting from stress in a family member caring for an advanced cancer patient

2021 ◽  
pp. 1-3
Author(s):  
Mayumi Ishida ◽  
Nozomu Uchida ◽  
Akira Yoshioka ◽  
Izumi Sato ◽  
Tetsuya Hamaguchi ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Family Member ◽  
Advanced Cancer ◽  
Family Members ◽  
The Body ◽  
Mental Condition ◽  
Wernicke Encephalopathy ◽  
Level Of Consciousness ◽  
Loss Of Appetite ◽  
Burden Of Caring

Abstract Objective It is well known that the burden on the families of cancer patient extends across many aspects, but there have been no reports of family members developing delirium due to the burden of caring for a cancer patient. Methods We reported a caregiver who developed Wernicke encephalopathy (WE) while caring for a family member with advanced cancer. Results The subject was a 71-year-old woman who had been caring for her husband, diagnosed with gastric cancer and liver metastases, for 5 months. She visited the “caregivers’ clinic” after referral by an oncologist who was worried about a deterioration in her mental condition that had appeared several weeks previously. The woman had a history of diabetes mellitus. Some giddiness was observed and, based on her inability to answer questions, her level of consciousness was checked and some disorientation was observed. She was diagnosed with delirium. A blood sample was collected to investigate the cause of the delirium, but the test data showed no hypoglycemia. Her appetite had declined since her husband was diagnosed with cancer. Thiamine deficiency was suspected as thiamine stores in the body are depleted within about 18 days and her loss of appetite had continued for 5 months. On intravenous injection of 100 mg of thiamine, her consciousness level was returned to normal in 1 h. A diagnosis of WE was supported by the patient's abnormally low serum thiamine level. Significance of the results The family members of cancer patients may develop a loss of appetite due to the burden of caring, resulting in WE. When providing care for signs of distress in family members, it is necessary to pay attention not only to the psychological aspects but also to their level of consciousness and physical aspects, particularly the possibility of serious illness resulting from reduced nutritional status.

Preferred lifestyle upon advanced cancer diagnosis: Comparison of perspectives of advanced cancer patients, family members, and physicians in Japan.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e20559-e20559
Author(s):  
Mioko Ikushima ◽  
Jiichiro Sasaki ◽  
Seigo Nakamura ◽  
Naomi Sakurai ◽  
Michiko Oki ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Cancer Diagnosis ◽  
Family Members ◽  
Advanced Cancer Patients ◽  
Comparison Of Perspectives

Measuring the impact of integrating palliative care into a multidisciplinary brain and spine oncology clinic.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 163-163
Author(s):  
Matthew Manning ◽  
Mary Larach ◽  
Susan Boyles ◽  
Abigail Stern
Keyword(s):  
Palliative Care ◽  
Treatment Options ◽  
Disease Status ◽  
Patient Characteristics ◽  
High Rate ◽  
Do Not Resuscitate ◽  
Goals Of Care ◽  
Cancer Centers ◽  
Metastatic Lung ◽  
The Impact

163 Background: Recent literature indicates that palliative care (PC) improves the outcomes of patients with cancer. Integration of PC providers into cancer centers is increasingly recognized to enhance symptom management with a beneficial effect on patient survival. In order to predict the impact of widespread PC integration, we hypothesized that a small pilot program may provide evidence supporting broader implementation. The current study endeavors to measure the result of adding a dedicated PC provider to a multidisciplinary brain and spine oncology program. Methods: Over the six month study period, a PC nurse practitioner was integrated into an existing weekly multidisciplinary brain and spine oncology conference and clinic. The provider participated in the multidisciplinary conference reviewing recent MRIs and discussing current disease status and treatment options. Following conference, the PC provider would consult on up to four of the clinic patients. Data were recorded regarding patient characteristics, goals of care, and changes in therapy. Results: The PC provider participated in 14 multidisciplinary clinics with a total of 180 subjects. Of those, 24 subjects met with the PC provider in formal consultation. The most common diagnoses were 41.6% with metastatic lung cancer and 25% with glioblastoma. For goals of care, an Advanced Directive discussion was documented in 100%. Do Not Resuscitate (DNR) orders were activated in 37.5% and documented in 54%. Medical Orders for Scope of Treatment (MOST) forms were introduced in 87.5% and completed in 25%. For changes in therapy, enrollment in hospice occurred in 33.3%. Pain medication was changed in 33.3%. Other symptoms including fatigue, weakness, anorexia, constipation, anxiety, lymphedema, dysphagia, depression, insomnia, and alopecia were managed in 87.5%. Conclusions: This study suggests that the integration of a PC provider into an existing multidisciplinary cancer program can produce a high rate of establishing goals of care and result in changes in treatment in a significant number of cases. Further study on the impact of integrating PC in cancer centers seems to be warranted.

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