K Laryionava1, P Heußner, W Hiddemann, E C Winkler. 1. Department of Medical Oncology, National Center for Tumor Diseases (NCT), Programme for Ethics and Patient-oriented Care, Heidelberg University Hospital , Im Neuenheimer Feld 460, 69120, Heidelberg, Germany, katsiaryna.laryionava@med.uni-heidelberg.de.
Abstract
BACKGROUND: Many patients with advanced cancer receive aggressive chemotherapy close to death and are referred too late to palliative or hospice care. AIM: The aim of this study was to investigate oncologists' and oncology nurses' perceptions of the optimal timing for discussions about forgoing cancer-specific therapy at the End-of-Life (EOL) and the reasons that might hinder them. DESIGN: Qualitative in-depth interviews with oncologists and oncology nurses were carried out. The empirical data were evaluated from a normative perspective. SETTING/PARTICIPANTS: Twenty-nine physicians and nurses working at the Department of Hematology and Oncology of a German university hospital were interviewed. RESULTS: Health-care professionals differed considerably in their understanding of when to initiate discussions about forgoing cancer-specific therapy at the EOL. However, their views could be consolidated into three approaches: (1) preparing patients gradually throughout the course of disease (anticipatory approach) which is best suited to empower patient self-determination in decision-making, (2) waiting until the patient him/herself starts the discussion about forgoing cancer-specific treatment, and (3) waiting until all tumor-specific therapeutic options are exhausted. CONCLUSION: The empirically informed ethical analysis clearly favors an approach that prepares patients for forgoing cancer-specific therapy throughout the course of disease. Since the last two approaches often preclude advance care planning, these approaches may be less ethically acceptable. The proposed framework could serve as a starting point for the development of concrete recommendations on the optimal timing for EOL discussions.
BACKGROUND: Many patients with advanced cancer receive aggressive chemotherapy close to death and are referred too late to palliative or hospice care. AIM: The aim of this study was to investigate oncologists' and oncology nurses' perceptions of the optimal timing for discussions about forgoing cancer-specific therapy at the End-of-Life (EOL) and the reasons that might hinder them. DESIGN: Qualitative in-depth interviews with oncologists and oncology nurses were carried out. The empirical data were evaluated from a normative perspective. SETTING/PARTICIPANTS: Twenty-nine physicians and nurses working at the Department of Hematology and Oncology of a German university hospital were interviewed. RESULTS: Health-care professionals differed considerably in their understanding of when to initiate discussions about forgoing cancer-specific therapy at the EOL. However, their views could be consolidated into three approaches: (1) preparing patients gradually throughout the course of disease (anticipatory approach) which is best suited to empower patient self-determination in decision-making, (2) waiting until the patient him/herself starts the discussion about forgoing cancer-specific treatment, and (3) waiting until all tumor-specific therapeutic options are exhausted. CONCLUSION: The empirically informed ethical analysis clearly favors an approach that prepares patients for forgoing cancer-specific therapy throughout the course of disease. Since the last two approaches often preclude advance care planning, these approaches may be less ethically acceptable. The proposed framework could serve as a starting point for the development of concrete recommendations on the optimal timing for EOL discussions.
Authors: David W Kissane; Carma L Bylund; Smita C Banerjee; Philip A Bialer; Tomer T Levin; Erin K Maloney; Thomas A D'Agostino Journal: J Clin Oncol Date: 2012-03-12 Impact factor: 44.544
Authors: Lara Traeger; Chelsea Rapoport; Emily Wright; Areej El-Jawahri; Joseph A Greer; Elyse R Park; Vicki A Jackson; Jennifer S Temel Journal: J Palliat Med Date: 2019-11-13 Impact factor: 2.947
Authors: Alex Z Fu; Kristi D Graves; Roxanne E Jensen; John L Marshall; Margaret Formoso; Arnold L Potosky Journal: J Cancer Res Clin Oncol Date: 2015-11-18 Impact factor: 4.553
Authors: Lara Fritz; Linda Dirven; Jaap C Reijneveld; Johan A F Koekkoek; Anne M Stiggelbout; H Roeline W Pasman; Martin J B Taphoorn Journal: Cancers (Basel) Date: 2016-11-08 Impact factor: 6.639
Authors: Katsiaryna Laryionava; Katja Mehlis; Elena Bierwirth; Friederike Mumm; Wolfgang Hiddemann; Pia Heußner; Eva C Winkler Journal: JMIR Res Protoc Date: 2018-06-15