Terminally Ill Taiwanese Cancer Patients' and Family Caregivers' Agreement on Patterns of Life-Sustaining Treatment Preferences Is Poor to Fair and Declines Over a Decade: Results From Two Independent Cross-Sectional Studies

Liu, Tsang Wu; Wen, Fur‐Hsing; Wang, Cheng‐Hsu; Hong, Ruey‐Long; Chow, Jyh Ming; Chen, Jen Shi; Chiu, Chang Fang; Tang, Siew Tzuh

doi:10.1016/j.jpainsymman.2017.02.013

Cited by 23 publications

(17 citation statements)

References 46 publications

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“…Interestingly we also found, that changing the therapeutic goal was an aspect which does explicitly not trigger IPCC requests; probably because requesting physicians consider it their own duty. This is confirmed by other studies with physicians asking for support in end of life care discussions, but not in changing the therapeutic goal [6,39,42,44].…”

Section: Discussionsupporting

confidence: 78%

“…Decision-making was narrated by a few PC specialists, while requesting physicians did not mentioned this trigger spontaneously. Studies show that decision-making is perceived as a relevant issue [42,43], but possibly not as easily recognized or as explicitly addressed as physical symptom burden. Interestingly we also found, that changing the therapeutic goal was an aspect which does explicitly not trigger IPCC requests; probably because requesting physicians consider it their own duty.…”

Section: Discussionmentioning

confidence: 99%

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Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Coym

Kanitz

Puls

et al. 2020

BMC Health Serv Res

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Background: Inpatient palliative care consultation (IPCC) teams have been established to improve care for patients with specialist palliative care (PC) needs throughout all hospital departments. The objective is to explore physicians' perceptions on the impact of IPCC, its triggers, challenges and limits, and their suggestions for future service improvements. Methods: A Qualitative study drawing on semi-structured interviews with 10 PC specialists of an IPCC team and nine IPCC requesting physicians from oncology and non-oncological departments of a university hospital. Analysis was performed using qualitative content analysis. Results: PC specialists and IPCC requesting physicians likewise considered organization of further care and symptom-burden as main reasons for IPCC requests. The main impact however was identified from both as improvement of patients' (and their caregivers') coping strategies and relief of the treating team. Mostly, PC specialists emphasized a reduction of symptom burden, and improvement of further care. Challenges in implementing IPCC were lack of time for both. PC specialists addressed requesting physicians' skepticism towards PC. Barriers for realization of IPCC included structural aspects for both: limited time, staff capacities and setting. PC specialists saw problems in implementing recommendations like disagreement towards their suggestions. All interviewees considered education in PC a sensible approach for improvement. Conclusions: IPCC show various positive effects in supporting physicians and patients, but are also limited due to structural problems, lack of knowledge, insecurity, and skepticism by the requesting physicians. To overcome some of these challenges implementation of PC education programs for all physicians would be beneficial.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Coym

Kanitz

Puls

et al. 2020

BMC Health Serv Res

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“…16 Our finding of poor-to-fair concordance between patients' preferred and received LSTs may be attributable to the family power to override the autonomy/wishes of conscious, competent patients. 37 This power is commonly exercised in medical care decision-making, including EoL care, 38 in deeply Confucian doctrine-influenced societies such as Taiwan.…”

Section: Discussionmentioning

confidence: 99%

Advance Care Planning Improves Psychological Symptoms But Not Quality of Life and Preferred End-of-Life Care of Patients With Cancer

Tang

Chen

Wen

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: This study was conducted to examine whether a longitudinal advance care planning (ACP) intervention facilitates concordance between the preferred and received life-sustaining treatments (LSTs) of terminally ill patients with cancer and improves quality of life (QoL), anxiety symptoms, and depressive symptoms during the dying process. Patients and Methods: Of 795 terminally ill patients with cancer from a medical center in Taiwan, 460 were recruited and randomly assigned 1:1 to the experimental and control arms. The experimental arm received an interactive ACP intervention tailored to participants’ readiness to engage in this process. The control arm received symptom management education. Group allocation was concealed, data collectors were blinded, and treatment fidelity was monitored. Outcome measures included 6 preferred and received LSTs, QoL, anxiety symptoms, and depressive symptoms. Intervention effectiveness was evaluated by intention-to-treat analysis. Results: Participants providing data had died through December 2017. The 2 study arms did not differ significantly in concordance between the 6 preferred and received LSTs examined (odds ratios, 0.966 [95% CI, 0.653–1.428] and 1.107 [95% CI, 0.690–1.775]). Participants who received the ACP intervention had significantly fewer anxiety symptoms (β, −0.583; 95% CI, −0.977 to −0.189; P= .004) and depressive symptoms (β, −0.533; 95% CI, −1.036 to −0.030; P= .038) compared with those in the control arm, but QoL did not differ. Conclusions: Our ACP intervention facilitated participants’ psychological adjustment to the end-of-life (EoL) care decision-making process, but neither improved QoL nor facilitated EoL care honoring their wishes. The inability of our intervention to improve concordance may have been due to the family power to override patients’ wishes in deeply Confucian doctrine–influenced societies such as Taiwan. Nevertheless, our findings reassure healthcare professionals that such an ACP intervention does not harm but improves the psychological well-being of terminally ill patients with cancer, thereby encouraging physicians to discuss EoL care preferences with patients and involve family caregivers in EoL care decision-making to eventually lead to patient value–concordant EoL cancer care.

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“…However, family caregivers play an important role in not only providing care to the patient but also as a source to help guide the patient with these difficult treatment decisions. While research has been conducted on patient family caregiver decision making within the context of dying patients [7–8] and patient and family caregiver preferences for involvement in treatment decisions [9–10], to date, there have been no reports comparing patients’ preferences and family caregivers’ preferences for the patients’ goals of care while making treatment decisions in an outpatient setting.…”

Section: Introductionmentioning

confidence: 99%

Analyzing Goals of Care in Advanced Cancer Patients and Their Family Caregivers: Evidence-based Research

2018

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ObjectiveThe study objective was to determine concordance between patients and family caregivers’ preferences for quality or length of life over time.BackgroundPatients with advanced cancer are confronted with difficult decisions throughout their course of treatment and at end of life (EOL). These decisions can be influenced by their family caregivers’ preferences for the patient’s cancer treatment.MethodsUsing a longitudinal, descriptive study design from an on-going study, data were collected on an adult sample of patients with advanced stage GI or lung cancers and their family caregivers (n=237). Using a one item visual analog scale (0–100 with higher number indicating a preference for length of life over quality of life), patients and family caregivers were asked “regarding your/your loved one’s care, what is most important to you right now?” Data were collected every 3 months until 15 months or patient’s death.ResultsAt enrollment, the preference scores between patients (48.5) and family caregivers (42.6) were closely aligned. At the last assessment prior to death, these scores diverged with the caregivers favoring goals associated with quality of life over length of life (p=.02).DiscussionPatients and family caregivers have differing preferences and these goals of care can change over time. Attention to these differences could be used to guide conversations between patients and family caregivers regarding preferences at EOL.

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Terminally Ill Taiwanese Cancer Patients' and Family Caregivers' Agreement on Patterns of Life-Sustaining Treatment Preferences Is Poor to Fair and Declines Over a Decade: Results From Two Independent Cross-Sectional Studies

Cited by 23 publications

References 46 publications

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Advance Care Planning Improves Psychological Symptoms But Not Quality of Life and Preferred End-of-Life Care of Patients With Cancer

Analyzing Goals of Care in Advanced Cancer Patients and Their Family Caregivers: Evidence-based Research

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