Advance Care Planning and End-of-Life Decision Making for Patients with Cancer

Agarwal, Rajiv; Epstein, Andrew S.

doi:10.1016/j.soncn.2018.06.012

Cited by 71 publications

(66 citation statements)

References 92 publications

(72 reference statements)

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“…Advance-care conversations and directives are increasingly used in high-income settings, seem to improve quality of life and quality of dying, and reduce unnecessary treatments [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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 skills and expertise: 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 ambiguity 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 ask patients directly for their preferences. Fear of confrontation with family members and lawsuits leads healthcare workers to carry out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in the 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 healthcare workers 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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Bereaved family members also have better psychological adjustment when patients undergo less aggressive treatments near end-of-life [ 182 ]. The majority of research on ACP involves hospitalized patients and those near end-of-life [ 183 , 184 , 185 , 186 ]; however, goals of care can be an ongoing and evolving discussion throughout metavivorship. Further research is needed to determine the optimal timing of ACP discussions for metavivors and their family caregivers.…”

Section: Discussionmentioning

confidence: 99%

Living with Metastatic Cancer: A Roadmap for Future Research

Tometich

Hyland

Soliman

et al. 2020

Cancers

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Living with metastatic cancer, or metavivorship, differs from cancer survivorship and has changed as novel treatments have increased survival time. The purpose of this narrative review is to describe factors that impact challenges in metavivorship within a conceptual framework to guide future research. This review focuses on the specific metavivorship outcomes of progressive disease, survival time, symptoms, distress, financial toxicity, and quality of life. We describe the predisposing, precipitating, and perpetuating (3P) model of metavivorship. Understanding the biological, psychological, and social 3P factors that contribute to the development and maintenance of challenges in metavivorship provides a roadmap for future research. Implications of this model include prevention by targeting predisposing factors, management of precipitating factors after onset of metastatic disease, and treatment of perpetuating factors to reduce symptoms and improve quality of life during the chronic phase of metavivorship. This can be accomplished through biopsychosocial screening efforts, monitoring of patient-reported outcomes, education and communication interventions, interdisciplinary symptom management, advance care planning, and behavioral interventions to cultivate psychological resilience.

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“…Advance care planning (ACP) can assist patients, their families, and medical teams in communicating with one another when a patient’s disease has become terminal [ 1 , 2 ]. Following a comprehensive ACP session, a declarant can sign an advance directive (AD), which is a formal document in which they can express their expected medical care measures in advance before their physical and mental capacities become incapacitated [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Overview of the Motivation of Advance Care Planning: A Study from a Medical Center in Taiwan

Lin

Hsu

et al. 2021

IJERPH

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(1) Background: Since Taiwan’s Patient Right to Autonomy Act took effect in 2019, up to ten thousand declarants have participated in advance care planning (ACP) and have signed advance directives (ADs). Relative to the entire population of Taiwan, only a small percentage have completed ACP. This study sought to understand the motivations of Taiwanese who have participated in ACP, so as to increase the percentage of individuals participating in ACP and signing ADs; (2) Objectives: To understand the motivations that drive Taiwanese individuals to participate in ACP discussions.; (3) Methods: A retrospective secondary data analysis was performed in this study. The participants consisted of declarants who completed their ACP at a medical center in Taiwan in 2019; (4) Results: During the study period, 946 individuals completed their ACP. Of those declarants, 66.7% were over 60 years of age; 66.5% completed the process in groups of three or more; 49.5% completed their ACP free of charge; and 35 declarants had designated a health care agent (HCA). The declarants’ four main motivations for participating in ACP were “looking forward to dying with dignity,” “making end-of-life preparations,” “fear of being a social and economic burden on family members,” and “reluctance to let family members take on the responsibility of making decisions.” Furthermore, statistically significant differences were observed between the declarants in terms of gender, age, designation of an HCA, and motivations for participating in ACP. Females, declarants aged below 60 years, and declarants with a designated HCA tended to participate in ACP due to “reluctance to let family members to take on the responsibility of making decisions”. Males, declarants aged above 60 years, and declarants without an HCA came for ACP because of “fear of being a social and economic burden on family members”. (5) Conclusions: The main motivations of Taiwanese individuals who sought ACP were to die with dignity and to have an early understanding of end-of-life treatment and care models. Secondly, these individuals hoped that their families would not have to take on the responsibility of making decisions. They also did not want to impact their families socially and economically. In this regard, providing economic subsidies might enhance the Taiwanese public’s intentions to seek ACP discussions on their own initiative.

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Advance Care Planning and End-of-Life Decision Making for Patients with Cancer

Abstract: Nurses can facilitate advance care planning and primary palliative care, to support patients and families to make informed and value-concordant decisions regarding cancer and end-of-life treatments.

Cited by 71 publications

References 92 publications

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

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

Living with Metastatic Cancer: A Roadmap for Future Research

Overview of the Motivation of Advance Care Planning: A Study from a Medical Center in Taiwan

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