Most Advance Directives Written by Patients With Advanced Cancer or Their Proxies Request Only Minimally Invasive Treatments During End-of-Life Care

Abstract

Although it is assumed that most patients with terminal cancer are reluctant to receive life-sustaining treatment, there is a paucity of evidence supporting this assumption. We retrospectively analyzed the advance directives of terminal cancer patients to determine the preferences of patients. Patients with cancer who had life expectancy of less than 6 months were admitted to a palliative care unit in Seoul Medical Center from March 2008 to February 2010. Among a total of 247 patients, advance directives were present in the medical records of 168 patients (68.0%). Most of the advance directives were written by the patients’ families (95.2%) and they stated that they did not want most of the invasive procedures. Patients with advanced cancer mostly requested that only minimally invasive treatments that eased suffering be performed.

Patients with delirium and advanced solid cancer in the emergency department: A challenge for the emergency practitioner, oncologist, and intensivist

“…Many studies have emphasized the importance of advance directives, which often are not collected or transmitted but may be of major importance in the case of a patient with cancer and delirium presenting to the ED . However, this is in contrast to the results of a study performed in patients with advanced cancer, which found that advance directives were present in 68.0% of the medical records, with the majority of them written by the patients' families (95.2%) and stating that they did not want most of the invasive procedures …”

Experience of Advance Directives in a Hospice Center

“…Although this value is lower comparing with the existing research, it is meaningful that all ADs were completed by patients themselves. Kwon et al ( 4 ) reported that 68% of patients in hospice centers had ADs completed, but only 4.8% were conducted by patients. The purpose of ADs is to reflect patients' self-determination and protect their autonomy.…”

“…In this study, it took the patients a median of three days to complete ADs, and they died 22 days after signing ADs. Kwon et al ( 4 ) reported that the median duration of survival after ADs were signed was nine days. In our study, ADs were completed relatively earlier; however, the duration of survival after the patients signed ADs is still very short.…”

“…Sun et al ( 3 ) reported that most terminal cancer patients in hospice centers had positive attitudes about the need of ADs. Although several hospitals have recently introduced ADs, ADs were not completed by patients but by their families in most cases ( 4 ). Because few patients have been given the right to decide end-of life care; to do or not to do ( 5 , 6 , 7 ), there has been a need of nationwide discussions on ADs.…”

Factors That Affect Health Professionals’ Preparation of Advanced Directives in Korea

“…Choi et al [24] reported that the rate of discontinuing life-prolonging treatment according to the patient's intent (69.0%) was higher than that according to the family or agent (50.5%). In the research of Kwon et al [25], in contrast, the form was prepared mostly by families (95.2%). Hence, with regard to who should make the form of AD and make decisions about meaningless life-prolonging treatment, opinions need to be gathered sufficiently from the medical circles, academic circles, civil organizations, public, patients, and guardians.…”