Preference for Aggressive End-of-Life Care among Advanced Cancer Patients in Wuhan, China: A Cross-Sectional Study

Abstract

Life-sustaining treatments (LSTs) and end-of-life (EOL) care’s goal for prolonging one’s life are defined as aggressive EOL care among critically ill patients. They have limited effects and add unnecessary financial burden to advanced cancer patients. A questionnaire survey was conducted to collect information on demographics, disease conditions, preference for LSTs, and goal of EOL care among advanced cancer patients of comprehensive grade-A tertiary hospitals in Wuhan, mainland China. Most patients preferred to accept LSTs when they were in a critical condition, including cardiopulmonary resuscitation (89.9%), mechanical ventilation support (85.7%), nasogastric tube feeding (84.1%), blood transfusion (89.8%), general surgery (87.5%), and hemodialysis (85.8%). Most (88%) preferred prolonging life as the goal of EOL care. Logistic regression showed common influencing factors were participants who completed junior high/high school or below and were financially adequate had higher reference for aggressive EOL care. Patients whose physician had accurately disclosed prognosis; however, showed a decrease trend for aggressive EOL care. Most advanced cancer patients preferred to accept aggressive EOL care. Discussions about prognosis disclosure among physicians and patients should be improved. Education about LSTs’ limitations and comfort-oriented care’s benefits should be promoted among the advanced cancer patients in mainland China.

Preferences for end‐of‐life care and decision‐making among Chinese community‐dwelling older adults: A comparative cross‐sectional study in Hong Kong and Wuhan in China

“…This finding is not surprising as the view of opting for aggressive treatments when patients' health status is reduced is prevailing in China (Gu et al, 2016). Previous research has found that Chinese patients who had little knowledge of EoL care or did not know or inaccurately understand their prognoses when approaching death were more likely to indicate this preference (Liao et al, 2020; Tam et al, 2021). Furthermore, a recent study in Taiwan showed that the discussion of EoL preferences with patients was associated with the option for less aggressive care (Chan et al, 2022).…”

“…This may be attributed to the differences in family culture between the two places. As the traditional Chinese culture emphasizes filial piety and familism, adult children in mainland China regard themselves having responsibilities to take care of their older parents physically and financially at EoL (Liao et al, 2020). By contrast, the HK participants had a lower preference for caring or dying at home.…”

Association Between Primary Decision-Maker and Care Intensity Among Patients With Advanced Cancer in Mainland China

“…8-10 While the emerging data are not conclusive, investigators attribute the observed care outcomes to a pattern of family-centered decision-making. 5,11-15…”

“…1,2 Despite the alarming rate of cancer-related mortality, little is known about endof-life (EOL) care of Chinese patients with advanced cancer. [3][4][5][6][7] Limited evidence suggests that Chinese patients with cancer may receive non-beneficial life-sustaining treatments in their final months, including high rates of intensive care unit (ICU) admission, mechanical ventilation, and tube feeding. [8][9][10] While the emerging data are not conclusive, investigators attribute the observed care outcomes to a pattern of family-centered decisionmaking.…”

“…[8][9][10] While the emerging data are not conclusive, investigators attribute the observed care outcomes to a pattern of family-centered decisionmaking. 5,[11][12][13][14][15] In recent years, decision-making in the treatment of serious illness has attracted interest from both academics and the public. 11,16,17 In North America and Europe, highquality end-of-life care planning has been associated with reduced non-beneficial life-sustaining treatments, 18,19 increased palliative care and hospice use, [20][21][22] and increased concordance of care with patient wishes.…”