Physician-patient end-of-life care discussions: Correlates and associations with end-of-life care preferences of cancer patients - A cross-sectional survey study

Siew Tzuh Tang*, Tsang Wu Liu, Li Ni Liu, Chang Fang Chiu, Ruey Kuen Hsieh, Chun Ming Tsai

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

42 Scopus citations

Abstract

Background: Honoring patients treatment preferences is a key component of high-quality end-of-life care. Connecting clinical practices to patients preferences requires effective communication. However, few cancer patients reported discussing end-of-lifecare preferences with their physicians. Aim: To identify correlates of physicianpatient end-of-life-care discussions and to investigate associations of physicianpatient endof- life-care discussions with patient end-of-life-care preferences. Design: A cross-sectional survey from April 2011 through November 2012. Setting/participants: A convenience sample of 2467 cancer patients (89.3% participation rate) whose disease was diagnosed as terminal and unresponsive to current curative cancer treatment was recruited from 23 teaching hospitals throughout Taiwan. Results: Only 7.8% of respondents reported discussing end-of-life-care preferences with their physicians. Physicians were more likely to discuss end-of-life-care preferences with cancer patients who accurately understood their prognosis but less likely to do so if patients were married or received care in a hospital with an inpatient hospice unit. Furthermore, physicianpatient end-of-life-care discussions were significantly, positively associated with the likelihood of preferring comfort-oriented care and hospice care, but negatively associated with preferences for receiving cardiopulmonary resuscitation when life is in danger and aggressive life-sustaining treatments at end of life, including intensive care unit admission, cardiac massage, intubation, and mechanical ventilation support. Conclusion: Physicianpatient end-of-life-care discussions are correlated with accurate prognostic awareness, marital status, and institutional characteristics and negatively associated with terminally ill cancer patients preferences for aggressive end-of-life care. Interventions should be developed to facilitate timely end-of-life-care discussions between at-risk patients and their physicians, thus honoring patients end-of-life-care preferences and possibly avoiding futile life-sustaining treatments.

Original languageEnglish
Pages (from-to)1222-1230
Number of pages9
JournalPalliative Medicine
Volume28
Issue number10
DOIs
StatePublished - 26 12 2014

Keywords

  • Advance care planning
  • end-of-life care
  • end-of-life-care discussions
  • physician-patient communication
  • preferences
  • terminal care

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