“Allow Natural Death” versus “Do Not Resuscitate”: What Do Patients with Advanced Cancer Choose?

Miljković, Miloš D.; Emuron, Dennis; Rhodes, Lori; Abraham, Joseph H.; Miller, Kenneth D.

doi:10.1089/jpm.2014.0369

Cited by 19 publications

(9 citation statements)

References 14 publications

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“…Factors associated with end‐of‐life care identified through this review are presented in Table 6 (Data S3). Patients with accurate PA were more likely to complete do‐not‐resuscitate orders (DNR), 2,3,7,51 use palliative care, 27,47,72 prefer treatment focused on comfort and quality of life, 30,34,45,57,59 and to use hospice care 30,45,57 . Patients with more accurate PA did not want to continue in life‐sustaining treatment 57 and they were not likely to be hospitalized in intensive care unit in the last year of their life 59,72 or in the last month 69 .…”

Section: Resultsmentioning

confidence: 99%

“…One potential solution for this dilemma of potential negative aspects of prognostic disclosure might be in tailoring communication about prognosis according to patients' preferences rather than focus on achieving accurate prognostic awareness itself while hoping that this will ease patients' suffering. Some of the studies included in this review showed that regardless their level of quality of life or depression, patients with better prognostic awareness more often make choices which can alleviate their suffering such as preferring comfort‐oriented care, 30,59 choosing hospice care, 30,45,57 and completing DNR orders 2,3,7,51 …”

Section: Discussionmentioning

confidence: 99%

“…Prognostic awareness (PA) relates to patients' capacity to understand their prognosis, shortened life expectancy and the likely development of the disease 1 . Understanding diagnosis and prognosis was found to facilitate end‐of‐life care planning, discussion about life‐prolonging treatment and establish do‐not‐resuscitate orders 2‐4 . Based on the current evidence, accurate PA is associated with decrease in depresivity and anxiety and with increase in quality of life 5,6 .…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with prognostic awareness in patients with cancer: A systematic review

Vlčková

Tučková

Poláková³

et al. 2020

Psycho-Oncology

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Objectives Prognostic awareness relates to patients' capacity to understand their prognosis and the likely illness trajectory. Based on the current evidence, accurate PA is associated with decrease in uncertainty, depresivity, and anxiety and with increase in quality of life. However, other studies found also negative associations of PA and quality of life and mental health. This systematic review synthesizes the available literature on factors associated with accurate prognostic awareness in patients with cancer. Methods Four databases were systematically searched for studies assessing prognostic awareness in patients with cancer. In these studies, we looked for factors positively or negatively associated with prognostic awareness. Included studies were critically appraised for methodological quality. Results We screened 28 078 studies and included 70. In these studies, 102 factors were found to be related to prognostic awareness positively or negatively. Identified factors were divided into seven groups: demographic factors, factors related to coping, health condition factors, psychological factors, factors associated with end‐of‐life care, factors related to communication, and factors related to relatives. Prognostic awareness differs according to age, personality, communication with doctor, disease stage, or being outpatient. For some factors such as depression, anxiety, or quality of life, higher level of these factors was found to be associated with accurate and inaccurate prognostic awareness. Conclusions Prognostic awareness is a complex phenomenon associated with various positive and negative associations for patients with cancer. Clinicians must consider individual preferences and values of patients and their families when discussing prognosis and must be prepared for potential adverse outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors associated with prognostic awareness in patients with cancer: A systematic review

Vlčková

Tučková

Poláková³

et al. 2020

Psycho-Oncology

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“…Even aside from physical comfort, patients facing imminent death have identified that other aspects of care are equally important to their wellbeing. This includes the need for excellent culturally-appropriate communication with their health care providers that allows an understanding of their prognosis and what to expect from interventions such as resuscitation [ 12 , 13 ].…”

Section: Other Care Needs In the Final Stages Of Lifementioning

confidence: 99%

Care at the Very End-of-Life: Dying Cancer Patients and Their Chosen Family’s Needs

Clark

2017

Cancers

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The majority of cancer deaths in countries such as Australia are predictable and most likely to occur in hospital. Despite this, hospitals remain challenged by providing the best care for this fragile cohort, often believing that care with palliative intent at the very end-of-life is not the best approach to care. Given the importance that dying patients place on excellent symptom control, failing to provide good end-of-life care is likely to be contrary to the wishes of the imminently dying patient and their family. This becomes even more significant when the impact of care on the bereavement outcomes of families is considered. Given the rising numbers of predicable hospital deaths, an urgent need to address this exists, requiring health professionals to be cognisant of specific care domains already identified as significant for both patients and those closest to them in knowledge, care and affection. This non-systematic review’s aims are to summarise the symptoms most feared by people imminently facing death which is defined as the terminal phase of life, where death is imminent and likely to occur within hours to days, or very occasionally, weeks. Further, this paper will explore the incidence and management of problems that may affect the dying person which are most feared by their family. The final section of this work includes a brief discussion of the most significant issues that require attention.

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“…Clinical guidelines recommend timely ACP and palliative care as vital components of person-centered cancer care (Ferrell et al, 2017;Institute of Medicine, 2014;Levy et al, 2016;Peppercorn et al, 2011), yet most patients with cancer do not have these important conversations (Nelson et al, 2011;Peppercorn et al, 2011;Wright et al, 2008). Over half of cancer patients report that their oncologists do not know their EOL care preferences (Miljkovic, Emuron, Rhodes, Abraham, & Miller, 2015;Nelson et al, 2011). Despite ongoing efforts to increase ACP, a national longitudinal study found no increase in EOL discussions or use of living wills among persons with cancer between 2000-2012 (Narang, Wright, & Nicholas, 2015).…”

Section: Introductionmentioning

confidence: 99%

Addressing personal barriers to advance care planning: Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers

et al. 2018

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The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods.ResultFour salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease.Significance of resultsThe MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.

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“Allow Natural Death” versus “Do Not Resuscitate”: What Do Patients with Advanced Cancer Choose?

Abstract: Background: Many patients with advanced cancer at our hospital request full resuscitative efforts at the end of life. We assessed the knowledge and attitudes of these patients towards end-of-life (EOL) care,

Cited by 19 publications

References 14 publications

Factors associated with prognostic awareness in patients with cancer: A systematic review

Factors associated with prognostic awareness in patients with cancer: A systematic review

Care at the Very End-of-Life: Dying Cancer Patients and Their Chosen Family’s Needs

Addressing personal barriers to advance care planning: Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers

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