Perspectives of Singaporean patients and caregivers towards quality of life or quantity of life with disease-modifying treatment in the end-of-life setting

Abstract

Background: Healthcare providers often struggle to balance the sometimes competing considerations of maximizing quality of life (QoL) and quantity of life with disease-modifying treatment (DMT). These decisions require in-depth dialog between all parties in order to understand the concerns and perspectives of the patient and caregiver in this period. Objectives: The objectives of this study were to explore Singaporean patients' and caregivers' attitudes towards QoL and DMT, and to examine the reasons behind their beliefs. Methods: Participants were given a video vignette of a family discussing how best to care for their mother who is recently diagnosed with cancer and were interviewed regarding their thoughts on QoL and DMT for a 70-year-old patient with stage IV metastatic cancer. Subjects/Setting: A total of 21 patients and caregivers were recruited from a tertiary oncology centre. Results: Both patients and caregivers show little support for pursuing QoL, despite the likely compromise to the patients' QoL. These participants believed that not pursuing DMT was tantamount to giving up and accepting death. Whilst patients did accept that in some circumstances a QoL approach would be acceptable, caregivers remained adamant upon a DMT approach. The perspectives of caregivers reflected the influence of the Confucian-inspired practice of filial piety. Conclusion: Local sociocultural beliefs and values continue to play a significant consideration in end-of-life decision-making. However, compliance with these beliefs have evolved, with greater consideration given to clinical and QoL factors.

Perceptions of Quality-of-life Advocates in a Southeast Asian Society

“…Design of this study was largely determined by social and cultural considerations [18][19][20]. To overcome local sensitivities with regards to discussing death and dying [7], we employed the use of video vignette and individual face-to-face semi-structured interviews with patients, their caregivers and/or their decisionmakers [18][19][20]. This is the first time that we are aware of that this approach has been adopted [18][19][20].…”

“…To overcome local sensitivities with regards to discussing death and dying [7], we employed the use of video vignette and individual face-to-face semi-structured interviews with patients, their caregivers and/or their decisionmakers [18][19][20]. This is the first time that we are aware of that this approach has been adopted [18][19][20]. Previous studies on death and dying in Singapore were limited to short interviews and there have been no studies that we are aware of that have studied the issue of QoL or QoL advocates in Confucian inspired family-centric communities [8,9,[18][19][20][21].…”

“…This is the first time that we are aware of that this approach has been adopted [18][19][20]. Previous studies on death and dying in Singapore were limited to short interviews and there have been no studies that we are aware of that have studied the issue of QoL or QoL advocates in Confucian inspired family-centric communities [8,9,[18][19][20][21]. The video vignette served to distance and depersonalizes discussions about death and dying which was critical given the study populations.…”

“…The video and the semi-structured questionnaire was designed by a panel of local experts and drew upon prevailing local data, feedback from patients, relevant theories, refined key issues that required addressing, psychological factors, participant's characteristics and cultural and religious factors [18][19][20].…”

Cross-sectional study assessing health outcome priorities of older adults with multimorbidity at a primary care setting in Singapore

“…There has yet to be a study assessing the health outcome priorities or the use of the OPT in an Asian primary care population. 7 There are intrinsic differences in sociocultural values 22 and the financial primary care models 23 24 between different countries and regions, which may potentially impact health outcome priorities. By studying the health outcome priorities of older adults with multimorbidity in Singapore’s primary care, family physicians will be better able to understand the varying health outcome preferences of this group of patients and the importance of identifying these preferences for shared decision-making.…”