Knowledge of end-of-life wishes by physicians and family caregivers in cancer patients

Abstract

Objectives To describe communication regarding cancer patient’s end-of-life (EoL) wishes by physicians and family caregivers. Methods An online questionnaire and telephone-based surveys were performed with physicians and family caregivers respectively in three teaching hospitals in Colombia which had been involved in the EoL care of cancer patients. Results For 138 deceased patients we obtained responses from physicians and family caregivers. In 32 % physicians reported they spoke to the caregiver and in 17 % with the patient regarding EoL decisions. In most cases lacking a conversation, physicians indicated the treatment option was “clearly the best for the patient” or that it was “not necessary to discuss treatment with the patient”. Twenty-six percent of the caregivers indicated that someone from the medical team spoke with the patient about treatment, and in 67% who had a conversation, caregivers felt that the provided information was unclear or incomplete. Physicians and family caregivers were aware if the patient had any advance care directive in 6% and 26% of cases, respectively, with low absolute agreement (34%). Conclusions There is a lack of open conversation regarding EoL in patients with advanced cancer with their physicians and family caregivers in Colombia. Communication strategies are urgently needed.

End of life of the cancer patient: patient, family and physician perceptions

“…The growing number of diseases like cancer and, consequently, of patients facing the end of their lives, has rekindled during the past two decades in different countries the debate about the care provided to these patients. Differences are found between the wishes of the patients and the opportunities to discuss those wishes, legal matters (for example, advance directives), as well as ethical and health considerations (3,25).…”

“…Support during this stage poses important dilemas to the healthcare professional, one of them being decision-making regarding the initiation or discontinuation of specific treatments for the disease (2,3). This scenario goes hand in hand with the challenge of dealing with difficult conversations with the patient and the family.…”

Pacientes y profesionales de la salud colombianos frente al final de la vida

“…Existe una limitada comunicación con respecto a los deseos y preferencias al final de la vida, entendidas como directivas anticipadas de atención, entre pacientes, médicos y cuidadores (8); "Los médicos no están capacitados para discutir la muerte con sus pacientes; tienden a ser ambiguos y abstractos y utilizan un vocabulario frío y técnico" (9). Cuando los pacientes y los profesionales de la salud evitan las conversaciones sobre los objetivos reales de la atención en estos escenarios, la proximidad repentina de la muerte puede hacer que las decisiones se tomen a partir del miedo y la confusión.…”

Cancer symptoms: do patients, family caregivers and professionals agree?

“…The main objective of palliative care is to improve the quality of life of patients and their families 3. To achieve this goal it is necessary to recognise that suffering depends on individual factors, and therefore it is impossible to provide high-quality palliative care without effective communication with patients and families 4…”

“…Agreement between patients, family caregivers and healthcare professionals regarding symptoms, quality of life and end-of-life preferences has been the focus of several studies 2 4–7. Family caregivers provide a reasonably accurate estimation of patients’ symptoms 2 8 9.…”