Factors That Impact End-of-Life Decision Making in African Americans With Advanced Cancer

Abstract

Significance-African Americans with cancer are less likely to use hospice services and more likely to die in the hospital than white patients with the same diagnosis. However, there is much that is not understood about the factors that lead African Americans to choose options for end-oflife care.Design-A qualitative, descriptive design was used in this pilot study.Methods-Interviews were conducted with two groups of African Americans with advancedstage cancer (people enrolled in hospice and those who were not under hospice care).Findings-End-of-life decisions were primarily guided by clinical factors, the patient-related physical, emotional, and cognitive symptoms that are sequelae of the underlying disease or medical treatments. The physician was the healthcare provider most likely to be involved in decision making with patients, family members, and caregivers. Individual factors, such as personal beliefs, influenced end-of-life decision making. Religion and spirituality were a topic in many interviews, but they did not consistently influence decision making.Discussion-Future studies should include interviews with family members, caregivers, and healthcare professionals so that factors that impact end-of-life decision making can be fully described. Strategies to facilitate recruitment will need to be added to future protocols.

End-of-Life Decision Making and Communication of Bereaved Family Members of African Americans with Serious Illness

“…10 Some AA patients prefer patient and family-centered care, 7,11-13 wherein they and their caregivers are actively involved in medical decision making, participate in discussions about treatment options, and give feedback about decisions. [12][13][14] Family members play an integral role in end-of-life decision making, 15 especially among AA patients; 7,[11][12][13] however, many patients and family members experience poor communication with HCPs regarding end-of-life treatments. 7,[16][17][18] Effective end-of-life communication has reduced end-of-life care resource use, shortened hospital stays, lowered intensive care unit mortality rates and costs, and increased use of comfort-focused care.…”

Factors Related to Spirituality for Terminally ill Cancer Patients through Life Review Interview in Japan

“…For example, the most common need identified in the current study was help with decision-making [9,10]. Men with advanced prostate cancer and their caregivers face complex, emotionally-laden decisions, such as beginning, changing or stopping anti-cancer treatment [5,6,10] or considering hospice [9]. Supporting decision making is a significant intervention used by throughout the disease trajectory by all member of the interdisciplinary team, especially the physician [5,6,9,10].…”

“…For example, the most common need identified in the current study was help with decision-making [9,10]. Men with advanced prostate cancer and their caregivers face complex, emotionally-laden decisions, such as beginning, changing or stopping anti-cancer treatment [5,6,10] or considering hospice [9].…”

“…Emotional and psychosocial needs of survivors with advanced prostate cancer and their caregivers are also very significant and may not always given the same priority as the physical needs. Important psychosocial needs for patient, intimate partner and other caregivers include support with decision-making [9,10], management of depression and anxiety, emotional support for changes in intimacy and sexual relationships [11][12][13][14], and identification of community resources [15,16], financial assistance, and assistance with advance care planning [15][16][17].…”

“…Given the complex needs of men with advanced prostate cancer survivors and their caregivers [4][5][6][10][11][12][13][14][15][16], it is important to know which needs can be met by health care providers and the needs that cannot be addressed in these clinical settings. Identification of these unmet needs can inform the development of interventions to support men with advanced prostate cancer and their caregivers and supplement the care that is being provided.…”