Medical decisions concerning the end of life for cancer patients in three Colombian hospitals – a survey study

Abstract

Background Cancer patients’ end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods Cancer patients who were at the end-of-life and attended in participating hospitals were identified. When these patients deceased, their attending physician was invited to participate. Attending physicians of 261 cancer patients (out of 348 identified) accepted the invitation and answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the first two decision types, we asked if the decision was fully or partially made with the intention or consideration that it may hasten the patient’s death. Results Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was fulfilled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n = 114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n = 38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. Conclusions Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance care directives and potentially life-shortening effects of treatment decisions. Specific end-of-life procedures, patients’ wishes, and availability of palliative care should be further investigated.

What medical conditions lead to a request for euthanasia? A rapid scoping review

“…Finally, it should be mentioned that some of our results may be rooted in publication biases 239 . Cancer is a prevalent illness with a high impact on public opinion, probably facilitating the euthanasia demands 240 . Indeed, both the general public and healthcare workers in many countries approve of the resort to euthanasia for cancer, especially in the terminal phases.…”

“… 239 Cancer is a prevalent illness with a high impact on public opinion, probably facilitating the euthanasia demands. 240 Indeed, both the general public and healthcare workers in many countries approve of the resort to euthanasia for cancer, especially in the terminal phases. On the contrary, some categories of euthanasia requests may be underrepresented because of contextual factors or the consequences of the illnesses.…”

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

“…Actualmente, los pacientes son muy vulnerables dentro del sistema de salud y además todavía hay un gran desconocimiento sobre sus derechos. En Colombia, requerimos con urgencia un apropiado desempeño del sistema de salud frente a la enfermedad avanzada, un compromiso férreo de los profesionales de la salud para ofrecer lo que los pacientes necesitan y a lo cual tienen derecho, y una sólida formación en comunicación de todos los actores (3).…”