Masanori Mori1, Chikako Shimizu2, Asao Ogawa3, Takuji Okusaka4, Saran Yoshida5, Tatsuya Morita6. 1. Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikataharacho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan. 2. Department of Breast Medical Oncology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan. cshimizu@hosp.ncgm.go.jp. 3. Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. 4. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. 5. Graduate School of Education, Tohoku University, 27-1, Kawauchi, Aoba-ku, Sendai, Miyagi, 980-8576, Japan. 6. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikataharacho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan.
Abstract
PURPOSE: End-of-life discussions (EOLd) including the option of forgoing anticancer treatment infrequently occur until treatment options have been exhausted for advanced cancer patients. We aimed to identify oncologist-related factors contributing to the timing of discussing the option of forgoing anticancer treatment. METHODS: In this nationwide survey of 864 medical oncologists, we asked about physicians' attitudes toward the timing of discussing the option of forgoing anticancer treatment for a simulated patient with newly diagnosed metastatic cancer, physicians' experience of EOLd, perceptions of a good death, and beliefs. Multivariate analyses identified determinants of early discussions. RESULTS: Among 490 physicians (response rate = 57%), 167 (35%) would discuss the option of forgoing anticancer treatment "now (at the diagnosis)." Physicians' attitudes toward discussing the option "now" were significantly correlated with a greater physician-perceived importance of life completion (odds ratio (OR) = 1.30, 95%CI = 1.00-1.69, p = 0.048) and dying in a preferred place (OR = 1.29, 95%CI = 1.01-1.65, p = 0.045) for a good death, and not perceiving EOLd as being severely distressing for patients/families (OR = 0.70, 95%CI = 0.54-0.95, p = 0.021). In multivariate analyses, independent determinants of the attitude toward discussing the option now included a greater physician-perceived importance of life completion for a good death (OR = 1.38, 95%CI = 1.05-1.81, p = 0.019), and not perceiving EOLd as being severely distressing for patients/families (OR = 0.70, 95%CI = 0.52-0.94, p = 0.017). CONCLUSIONS: Reflection by oncologists on their own perception regarding a good death and beliefs about EOLd may help oncologists individualize the timing of discussing the option of forgoing anticancer treatment.
PURPOSE: End-of-life discussions (EOLd) including the option of forgoing anticancer treatment infrequently occur until treatment options have been exhausted for advanced cancerpatients. We aimed to identify oncologist-related factors contributing to the timing of discussing the option of forgoing anticancer treatment. METHODS: In this nationwide survey of 864 medical oncologists, we asked about physicians' attitudes toward the timing of discussing the option of forgoing anticancer treatment for a simulated patient with newly diagnosed metastatic cancer, physicians' experience of EOLd, perceptions of a good death, and beliefs. Multivariate analyses identified determinants of early discussions. RESULTS: Among 490 physicians (response rate = 57%), 167 (35%) would discuss the option of forgoing anticancer treatment "now (at the diagnosis)." Physicians' attitudes toward discussing the option "now" were significantly correlated with a greater physician-perceived importance of life completion (odds ratio (OR) = 1.30, 95%CI = 1.00-1.69, p = 0.048) and dying in a preferred place (OR = 1.29, 95%CI = 1.01-1.65, p = 0.045) for a good death, and not perceiving EOLd as being severely distressing for patients/families (OR = 0.70, 95%CI = 0.54-0.95, p = 0.021). In multivariate analyses, independent determinants of the attitude toward discussing the option now included a greater physician-perceived importance of life completion for a good death (OR = 1.38, 95%CI = 1.05-1.81, p = 0.019), and not perceiving EOLd as being severely distressing for patients/families (OR = 0.70, 95%CI = 0.52-0.94, p = 0.017). CONCLUSIONS: Reflection by oncologists on their own perception regarding a good death and beliefs about EOLd may help oncologists individualize the timing of discussing the option of forgoing anticancer treatment.
Authors: E H Bradley; D V Cicchetti; T R Fried; D M Rousseau; R Johnson-Hurzeler; S V Kasl; S M Horwitz Journal: J Palliat Care Date: 2000 Impact factor: 2.250
Authors: Ezekiel J Emanuel; Yinong Young-Xu; Norman G Levinsky; Gail Gazelle; Olga Saynina; Arlene S Ash Journal: Ann Intern Med Date: 2003-04-15 Impact factor: 25.391