End-of-life care preferences among cancer patients in Southern Thailand: a university hospital-based cross-sectional survey

Abstract

Background End-of-life care preferences may be highly individual, heterogenic, and variable according to culture and belief. This study aimed to explore preferences and factors associated with end-of-life care among Thai cancer patients. Its findings could help optimize the quality of life of palliative cancer patients. Methods A cross-sectional study surveyed palliative cancer outpatients at Songklanagarind Hospital from August to November 2020. The questionnaires inquired about: (1) personal and demographic information, (2) experiences with end-of-life care for their relatives, and (3) end-of-life care preferences. To determine end-of life preferences, the data were analyzed using descriptive statistics. The data concerning patient demographics and end-of-life care preferences were compared using Fisher’s exact test. Results The majority of the 96 palliative cancer outpatients were female (65.6 %), and the overall mean age was 55.8 ± 11.6 years. More than half of them had an experience of observing someone die (68.8 %), and they were predominantly being conscious until the time of death (68.2 %). Most participants preferred receiving the full truth satisfied with the care their relatives had received in passing away at home surrounded by family (47.0 %) and regarding their illness (99.0 %), being free of uncomfortable symptoms (96.9 %), having their loved ones around (93.8 %), being mentally aware at the last hour (93.8 %), and having the sense of being meaningful in life (92.7 %). Their 3 most important end-of-life care wishes were receiving the full truth regarding their illness, disclosing the full truth regarding their illness to family members, and passing away at home. Conclusions In order to optimize the quality of life of palliative cancer patients, end-of-life care should ensure they receive the full truth regarding their illness, experience no distressing symptoms, remain mentally aware at the last hour of life, feel meaningful in life, and pass away comfortably with loved ones around.

General population-based study on preferences towards end-of-life care in Southern Thailand: a cross-sectional survey

“…Moreover, the top 3 most important components regarding EoL care wishes were: receiving the full truth about their illnesses, not being a burden to the family, and participating or performing in religious rituals. These findings were concordant with earlier reports from the USA [ 23 ] together with a study regarding Thai elderly people [ 12 ], and Thai palliative cancer patients [ 14 ]. A reason for this may be due to most participants in this study being older adults with a mean age of 54 years.…”

“…This issue might be a universal need among all people and patients in regards to quality of life when receiving EoL care. Moreover, this finding was similar to a prior study among Thai palliative cancer patients [ 14 ] highlighting that pain management was still an unsolved issue needing more attention from physicians tasked with identifying and alleviating pain and other distressing symptoms [ 26 ]. Therefore, patients’ anxiety about the management of their suffering, by the healthcare system, during their EoL period should be tackled.…”

“…Potential explanations could be that when someone chooses to pass away at home, this may increase the physical and psychological burden to family members. Furthermore, for some patients, dying with a sense of meaning and being remembered after death might be more significant than the place of death [ 14 , 33 ]. Choosing to die in a hospital may be preferable for the caregivers of palliative patients [ 34 ] because of the difficulties associated with palliative home care due to factors such as poor family networks and/or low levels of home care support from the public health system [ 35 , 36 ].…”

“…Thus, it may be a good representation of a southern province, which has a mixture of cultures and beliefs. To our knowledge, no study on EoL care preferences has been conducted in the southern region of Thailand over the past decade apart from a recent survey in regards to cancer patients [ 14 ]. Therefore, this study aims were to evaluate Thai peoples’ preferences about EoL care interventions for themselves and their relatives and to evaluate factors associated with these preferences; in regards to all age groups.…”

The relationship between futile medical care and respect for patient dignity: a cross-sectional study

“…Patients' perceptions of the dignity and meaning of life can help them prepare for death [16]. Pitanupong et al (2021) found that cancer patients in end-of-life care wanted to receive the full truth about their disease rather than experience any distressing symptoms, were mentally aware in the last hour of life, felt meaningful in life, and could pass away with their loved ones around [17]. According to studies, half of admitted patients experience "loss of dignity" during futile care, with patients in intensive care units being at a higher risk [18].…”