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Mori M, Chan HYL, Lin CP, Kim SH, Ng Han Lip R, Martina D, Yuen KK, Cheng SY, Takenouchi S, Suh SY, Menon S, Kim J, Chen PJ, Iwata F, Tashiro S, Kwok OLA, Peng JK, Huang HL, Morita T, Korfage IJ, Rietjens JAC, Kizawa Y. Definition and recommendations of advance care planning: A Delphi study in five Asian sectors. Palliat Med 2024:2692163241284088. [PMID: 39390784 DOI: 10.1177/02692163241284088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
BACKGROUND In Confucian-influenced Asian societies, explicit end-of-life conversations are uncommon and family involvement in decision-making is crucial, which complicates the adoption of culturally sensitive advance care planning. AIM To develop a consensus definition of advance care planning and provide recommendations for patient-centered and family-based initiatives in Asia. DESIGN A five-round Delphi study was performed. The rating of a definition and 84 recommendations developed based on systematic reviews was performed by experts with clinical or research expertise using a 7-point Likert scale. A median = 1 and an inter-quartile range = 0-1 were considered very strong agreement and very strong consensus, respectively. SETTING/PARTICIPANTS The Delphi study was carried out by multidisciplinary experts on advance care planning in five Asian sectors (Hong Kong/Japan/Korea/Singapore/Taiwan). RESULTS Seventy-seven of 115 (67%) experts rated the statements. Advance care planning is defined as "a process that enables individuals to identify their values, to define goals and preferences for future medical treatment and care, to discuss these values, goals, and preferences with family and/or other closely related persons, and health-care providers, and to record and review these preferences if appropriate." Recommendations in the domains of considerations for a person-centered and family-based approach, as well as elements, roles and tasks, timing for initiative, policy and regulation, and evaluations received high levels of agreement and consensus. CONCLUSIONS Our definition and recommendations can guide practice, education, research, and policy-making in advance care planning for Asian populations. Our findings will aid future research in crafting culturally sensitive advance care planning interventions, ensuring Asians receive value-aligned care.
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Affiliation(s)
- Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Helen Y L Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St Mary's Hospital, Incheon Metropolitan City, Republic of Korea
| | | | - Diah Martina
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Kwok Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Sayaka Takenouchi
- Department of Nursing Ethics, Division of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
- Department of Medicine, College of Medicine, Dongguk University, Seoul, Republic of Korea
| | - Sumytra Menon
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jungyoung Kim
- Safety and Health Department, Catholic Kwandong University, International St Mary's Hospital, Incheon Metropolitan City, Republic of Korea
| | - Ping-Jen Chen
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Futoshi Iwata
- Faculty of Law, Kanagawa University, Kanagawa, Japan
| | - Shimon Tashiro
- Department of Sociology, Graduate School of Arts and Letters, Tohoku University, Sendai, Japan
| | - Oi Ling Annie Kwok
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong
| | - Jen-Kuei Peng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Yoshida S, Hirai K, Ohtake F, Masukawa K, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Preferences of bereaved family members on communication with physicians when discontinuing anticancer treatment: referring to the concept of nudges. Jpn J Clin Oncol 2024; 54:787-796. [PMID: 38553776 PMCID: PMC11228860 DOI: 10.1093/jjco/hyae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/11/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND This study aimed to clarify the situation and evaluate the communication on anticancer treatment discontinuation from the viewpoint of a bereaved family, in reference to the concept of nudges. METHODS A multi-center questionnaire survey was conducted involving 350 bereaved families of patients with cancer admitted to palliative care units in Japan. RESULTS The following explanations were rated as essential or very useful: (i) treatment would be a physical burden to the patient (42.9%), (ii) providing anticancer treatment was impossible (40.5%), (iii) specific disadvantages of receiving treatment (40.5%), (iv) not receiving treatment would be better for the patient (39.9%) and (v) specific advantages of not receiving treatment (39.6%). The factors associated with a high need for improvement of the physician's explanation included lack of explanation on specific advantages of not receiving treatment (β = 0.228, P = 0.001), and lack of explanation of 'If the patient's condition improves, you may consider receiving the treatment again at that time.' (β = 0.189, P = 0.008). CONCLUSIONS Explaining the disadvantages of receiving treatment and the advantages of not receiving treatment, and presenting treatment discontinuation as the default option were effective in helping patients' families in making the decision to discontinue treatment. In particular, explanation regarding specific advantages of not receiving treatment was considered useful, as they caused a lower need for improvement of the physicians' explanation.
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Affiliation(s)
- Saran Yoshida
- Graduate School of Education, Tohoku University, Sendai, Miyagi, Japan
| | - Kei Hirai
- Graduate School of Human Science, Osaka University, Suita, Osaka, Japan
| | - Fumio Ohtake
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Osaka, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Hasegawa T, Okuyama T, Akechi T. The trajectory of prognostic cognition in patients with advanced cancer: is the traditional advance care planning approach desirable for patients? Jpn J Clin Oncol 2024; 54:507-515. [PMID: 38336476 PMCID: PMC11075734 DOI: 10.1093/jjco/hyae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
Most patients with advanced cancer initially express a desire to be informed of their prognosis, and prognostic discussions between patients and their oncologists can trigger the subsequent trajectory of prognostic cognitions. On the continuum of prognostic cognition, including inaccurate/accurate prognostic awareness (awareness of incurability of cancer, terminal nature of illness or life expectancy) and prognostic acceptance (accepting one's prognosis), patients' perceptions of being informed of their prognosis by oncologists and patients' coping strategy for serious medical conditions regulate prognostic cognitions. However, nearly half of the patients with advanced cancer have poor prognostic awareness, and few patients achieve prognostic acceptance. These phenomena partly act as barriers to participation in advance care planning. When oncologists engage in advance care planning conversations, they must assess the patient's prognostic cognition and readiness for advance care planning. Considering the inaccurate prognostic awareness in a non-negligible proportion of patients and that astatic patients' preferences for future treatment and care are influenced by prognostic cognition, more research on decision-making support processes for high-quality and goal-concordant end-of-life care is needed along with research of advance care planning. In addition to making decisions regarding future medical treatment and care, oncologists must engage in continuous and dynamic goal-of-care conversations with empathic communication skills and compassion from diagnosis to end-of-life care.
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Affiliation(s)
- Takaaki Hasegawa
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Toru Okuyama
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Psychiatry/Palliative Care Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Tatsuo Akechi
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Abe A, Takeuchi M, Kobayashi M, Kohno T, Mimura M, Fujisawa D. Qualitative analysis of expressions used in the end-of-life discussions and their associated factors. Palliat Support Care 2024; 22:374-380. [PMID: 37818655 DOI: 10.1017/s1478951523001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Discussing end-of-life (EOL) issues with patients remains challenging for health professionals. Physicians may use various expressions, including euphemistic ones, when disclosing the prognosis to their patients to reduce their psychological impact. However, the actual expressions of EOL disclosure in clinical practice are unclear. This study aims to investigate the expressions used in EOL disclosures and explore their associated factors. METHODS A retrospective chart review was conducted enrolling all the patients who died in a university-affiliated hospital. Expressions used in the EOL disclosure were qualitatively analyzed. The patients' participation rate and length from the discussion to death were investigated. RESULTS EOL disclosures were observed in 341 of 358 patients. The expressions used by the physicians were categorized into 4 groups; Group 1: Clear presentation of life expectancy (n = 106; 31.1%), Group 2: Euphemistic presentation of life expectancy (n = 24; 7.0%), Group 3: Presentation of risk of sudden death (n = 147; 43.1%), Group 4: No mention on life expectancy (n = 64; 18.8%). The proportion of male patients was higher in Group 2 (79%) and lower in Group 4 (56%). Patients with cancer accounted for approximately 70% of Groups 1 and 4, but only approximately 30% of Group 3. The patient participation rate was highest in Group4 (84.4%), followed by Group 2 (50.0%). The median time from EOL disclosure to death was longer in Groups 1 and 4 (26 and 29.5 days, respectively), compared to Groups 2 and 3 (18.5 and 16 days, respectively). SIGNIFICANCE OF RESULTS A variety of expressions are used in EOL disclosure. Patterns of communication are influenced by patients' gender and type of illness (cancer or noncancer). Euphemisms do not seem to facilitate timely disclosure of life expectancy or patient participation. For health professionals, not only devising the expressions to alleviate their patients' distress when breaking bad news but also considering the communication process and patient background are essential.
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Affiliation(s)
- Akiko Abe
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Palliative Care Center, Keio University School of Medicine, Tokyo, Japan
| | - Mari Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Palliative Care Center, Keio University School of Medicine, Tokyo, Japan
| | | | - Takashi Kohno
- Department of Cardiology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Palliative Care Center, Keio University School of Medicine, Tokyo, Japan
- Division of Patient Safety, Keio University Hospital, Tokyo, Japan
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Chuang YH, Wang CC, Hsiao CY, Lu CY, Wu JC, Hou WH. Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study. BMJ Open 2024; 14:e075693. [PMID: 38309751 PMCID: PMC10840022 DOI: 10.1136/bmjopen-2023-075693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan. DESIGN In-depth interviews and thematic analysis. SETTING Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022. PARTICIPANTS 21 outpatients with at least three visits for DJD and who were aware of SDM. RESULTS Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations. CONCLUSIONS In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.
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Affiliation(s)
- Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei, Taiwan
| | - Chih-Chien Wang
- College of Management, Da-Yeh University, Changhua, Taiwan
- Graduate Institute of Information Management, National Taipei University, Taipei, Taiwan
| | - Chih-Yin Hsiao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yeh Lu
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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Lu Q, Liu Q, Fang S, Ma Y, Zhang B, Li H, Song L. Relationship between fear of progression and symptom burden, disease factors and social/family factors in patients with stage-IV breast cancer in Shandong, China. Cancer Med 2024; 13:e6749. [PMID: 38457242 PMCID: PMC10923048 DOI: 10.1002/cam4.6749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 09/13/2023] [Accepted: 09/30/2023] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE To assess fear of progression (FoP)'s relationship with symptom burden and disease and social/family factors, as well as, determine the status of FoP in women with stage-IV breast cancer in Shandong, China. METHODS Two hundred and sixteen women were recruited from the department of breast cancer internal medicine, Shandong Cancer Hospital and Institute. Data for this observational study were collected between October 2020 and January 2021 using the MD Anderson Symptom Inventory, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and a participant information scale. SPSS 23.0 was used for statistical analysis. RESULTS After excluding invalid responses, the data of 200 participants were analysed. The average total FoP-Q-SF score was 29.39 ± 9.39 (95% confidence interval, 21.81-27.64). The FoP level among the participants was relatively low. For disease and social/family factors, FoP statistically significantly differed by satisfaction with family emotional support and the Eastern Cooperative Oncology Group (ECOG) score. The ECOG score was positively correlated with FoP. Furthermore, symptom burden was positively correlated with FoP. CONCLUSIONS Among patients with stage-IV breast cancer, satisfaction with family emotional support, ECOG score and symptom burden play key roles in FoP. Interventions, including providing appropriate emotional support from family, improving physical fitness and relieving symptom burden, must be considered in future studies, which may improve patients' overall physical and mental status and provide a supportive therapeutic environment.
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Affiliation(s)
- Qianrun Lu
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Qiuyue Liu
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Shu Fang
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Yujin Ma
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Baoxuan Zhang
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Huihui Li
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Lihua Song
- Department of Breast Cancer Internal MedicineShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
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Nahm SH, Subramaniam S, Stockler MR, Kiely BE. Timing of prognostic discussions in people with advanced cancer: a systematic review. Support Care Cancer 2024; 32:127. [PMID: 38261070 DOI: 10.1007/s00520-023-08230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/03/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Many people with cancer (patients) want to know their prognosis (a quantitative estimate of their life expectancy) but this is often not discussed or poorly communicated. The optimal timing of prognostic discussions with people with advanced cancer is highly personalised and complex. We aimed to find, organise, and summarise research regarding the timing of discussions of prognosis with people with advanced cancer. METHODS We conducted a systematic review of publications from databases, clinical practice guidelines, and grey literature from inception to 2023. We also searched the reference lists of systematic reviews, editorials, and clinical trial registries. Eligibility criteria included publications regarding adults with advanced cancer that reported a timepoint when a discussion of prognosis occurred or should occur. RESULTS We included 63 of 798 identified references; most of which were cross-sectional cohort studies with a range of 4-9105 participants. Doctors and patients agreed on several timepoints including at diagnosis of advanced cancer, when the patient asked, upon disease progression, when there were no further anti-cancer treatments, and when recommending palliative care. Most of these timepoints aligned with published guidelines and expert recommendations. Other recommended timepoints depended on the doctor's clinical judgement, such as when the patient 'needed to know' or when the patient 'seemed ready'. CONCLUSIONS Prognostic discussions with people with advanced cancer need to be individualised, and there are several key timepoints when doctors should attempt to initiate these conversations. These recommended timepoints can inform clinical trial design and communication training for doctors to help improve prognostic understanding.
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Affiliation(s)
- Sharon H Nahm
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Shalini Subramaniam
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia
- Bankstown Cancer Centre, Sydney, Australia
| | - Martin R Stockler
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia
- Concord Cancer Centre, Sydney, Australia
| | - Belinda E Kiely
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia.
- Concord Cancer Centre, Sydney, Australia.
- Macarthur Cancer Therapy Centre, Sydney, Australia.
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Gage L, Teply M. The Next Best Thing: Three Key Conversations to Convey Prognosis Over the Course of an Incurable Cancer. Clin Colorectal Cancer 2023; 22:354-360. [PMID: 37507247 DOI: 10.1016/j.clcc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Waiting until a person is very near end of life to discuss limited life expectancy risks lower goal-concordant care and increased utilization of medical interventions with lower likelihood of benefit at the end of life. Medical training on communication skills in serious illness often focuses on early and late conversations regarding prognosis, with no guidance on navigating the conversations occurring in the middle of the illness course. GOAL OF THE REVIEW We propose a new framework for identifying and discussing prognosis at various points along the cancer course, as a continuum from beginning to end, that is prompted by changes in clinical status and number of available remaining cancer directed interventions. DISCUSSION SPIKES is a framework utilized for early conversations in a cancer course. REMAP is a framework utilization for late conversations in a cancer course. There is a gap in guidance on how to navigate conversations that occur between the early and late phases of a cancer course. We describe 3 general phases of care during a cancer course ("early," "middle," and "late"), with each phase warranting specific communication skills in order to improve patient understanding of prognosis, goal concordant care, and best practices for healthcare utilization in the acute and end of life care settings. CONCLUSION Framing prognosis by available medical interventions through a framework of "early," "middle," and "late" adds clarity to the phase of illness, expectations around delivery of information to the patient, and framing of recommendations at each given phase.
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Affiliation(s)
- Lindsay Gage
- University of Nebraska Medical Center, Omaha, NE
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Yoshida S, Shimizu K, Matsui M, Fujimori M, Uchitomi Y, Horibe K. Preferred Communication with Adolescent and Young Adult Patients Receiving Bad News About Cancer. J Adolesc Young Adult Oncol 2023; 12:561-568. [PMID: 36367705 DOI: 10.1089/jayao.2022.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Several studies have investigated good communication practices with adult patients receiving bad news about cancer. However, while communication preferences may differ between adults and adolescent and young adult (AYA) patients, these preferences have not been determined for AYA patients. The primary endpoint of this study was to describe the communication preferred by AYA patients with cancer. Methods: The study cohort consisted of 15 patients who received a cancer diagnosis at the age of 15-29 years. Patients were recruited at the National Cancer Center Hospital or through "STAND UP!!," an association of AYA patients with cancer. Semistructured interviews were conducted, and content analysis was performed to analyze the data. Results: For the preferred communication of AYA patients, 80 categories were extracted in the following five domains: (1) "Supportive setting," (2) "Method of disclosure of bad news," (3) "Information given," (4) "Emotional support," and (5) "Support for the patient's decision making." Although more than half of the categories extracted were identical to the preferred communication of adult patients, some categories specific to AYA patients were identified that physicians should consider. Preferences specific to AYA patients included mentioning generation-specific social factors, not showing excessive empathy, and communicating in a manner considering their age and cognitive development that supports their decision making. Conclusion: Although physicians should be mindful of the specific preferences of AYA patients, the basic attitude and communication preferences are similar to those of patients of other generations.
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Affiliation(s)
- Saran Yoshida
- Division of Clinical Psychology, Graduate School of Education, Tohoku University, Sendai, Japan
| | - Ken Shimizu
- Department of Psycho-Oncology, Cancer Institute Hospital of JFCR, Koto-ku, Japan
| | - Motohiro Matsui
- Department of Pediatric Hematology Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Maiko Fujimori
- Division of Supportive Care, Survivorship and Translational Research, Institute for Cancer Control, National Cancer Center, Chuo-ku, Japan
| | - Yosuke Uchitomi
- Division of Supportive Care, Survivorship and Translational Research, Institute for Cancer Control, National Cancer Center, Chuo-ku, Japan
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Mori M, Lin CP, Cheng SY, Suh SY, Takenouchi S, Ng R, Chan H, Kim SH, Chen PJ, Yuen KK, Fujimori M, Yamaguchi T, Hamano J, Kizawa Y, Morita T, Martina D. Communication in Cancer Care in Asia: A Narrative Review. JCO Glob Oncol 2023; 9:e2200266. [PMID: 37364221 PMCID: PMC10497295 DOI: 10.1200/go.22.00266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, United Kingdom
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Sayaka Takenouchi
- Department of Nursing Ethics, Division of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Raymond Ng
- Palliative and Supportive Care, Woodlands Health, Singapore, Singapore
| | - Helen Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St Mary's Hospital, Incheon, South Korea
| | - Ping-Jen Chen
- Department of Family Medicine, Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
| | - Kwok Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Maiko Fujimori
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Hamano
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Diah Martina
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Psychosomatic and Palliative Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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11
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Hiratsuka Y, Hamano J, Mori M, Maeda I, Morita T, Suh SY. Prediction of Survival in Patients with Advanced Cancer: A Narrative Review and Future Research Priorities. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2023; 26:1-6. [PMID: 37753320 PMCID: PMC10519719 DOI: 10.14475/jhpc.2023.26.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make end-of-life decisions. The clinician's prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician's prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Hamano
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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12
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Lewis ET, Hammill K, Culbert R, van der Merwe M, Sahay A, Turner R, Cardona M. Delivering Prognostic News to Older People with Chronic Disease: What Format Preference and Level of Involvement in Decision Making? A Hospital Survey. Healthcare (Basel) 2023; 11:healthcare11030444. [PMID: 36767019 PMCID: PMC9913994 DOI: 10.3390/healthcare11030444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Shared decision making near end of life is a balancing act of communicating prognosis to patients and their surrogates/families and engaging them in considering value-concordant management choices. This cross-sectional survey aimed to determine the format in which older patients with chronic illnesses would prefer to receive prognostic information on their treatment options and disease progression, and their desired level of engagement in decision making. With a 60% participation rate, 139 inpatients in two hospitals and five surrogates were presented with six hypothetical scenarios with a randomly assigned sequence: verbal and written summary, graph, table, photo, video, and pamphlet. The majority (76%) of respondents chose the traditional verbal communication of prognosis by their doctor with a written summary as a reference and to share with family; the second choice was a condition-specific pamphlet (63%). Many found the graph and photo to be distressing (36% and 42%, respectively). Most (71%) wanted to know everything about their condition trajectory, and 63% chose shared decision making rather than completely autonomous or full delegation to clinicians or family. There were no gender differentials between wanting to know it all, supporting shared decision making or the preferred format for breaking news (p > 0.05). Older hospitalized patients with chronic conditions are willing to discuss end-of-life issues, learn about their prognosis, and be involved in shared decision making. Innovative formats such as graphs, videos, or photos were not welcome as part of the prognostic discussion.
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Affiliation(s)
- Ebony T. Lewis
- School of Population Health, University of New South Wales, Sydney 2052, Australia
- School of Psychology, The University of New South Wales, Sydney 2052, Australia
- Correspondence:
| | - Kathrine Hammill
- School of Science and Health, Western Sydney University, Campbelltown 2560, Australia
| | - Rebekah Culbert
- Occupational Therapy Services, Camden and Campbelltown Hospitals, Campbelltown 2560, Australia
| | | | - Ashlyn Sahay
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Mackay 4740, Australia
| | - Robin Turner
- Biostatistics Unit, Otago Medical School, University of Otago, Dunedin 9054, New Zealand
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Bond University, Robina 4226, Australia
- EBP Professorial Unit, Gold Coast University Hospital, Southport 4215, Australia
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13
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Hiratsuka Y, Oishi T, Miyashita M, Morita T, Mack JW, Imai H, Mori T, Sakayori M, Mori M, Maeda I, Hamano J, Ishioka C, Inoue A. Prognostic awareness in Japanese patients with advanced cancer: a follow-up cohort study. Jpn J Clin Oncol 2023; 53:410-418. [PMID: 36647604 DOI: 10.1093/jjco/hyad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with advanced cancer have been reported to be more likely to receive goal-concordant care if they have accurate prognostic awareness. However, many patients do not have this awareness. This study aimed to examine the prognostic awareness among Japanese patients with advanced cancer. METHODS This single-center, follow-up cohort study included Japanese patients with advanced cancer who received chemotherapy at Tohoku University Hospital between January 2015 and January 2016. Patients were surveyed at enrollment and followed up for clinical events for 5 years thereafter. We compared (i) the patients' prognostic awareness with both actual survival time and physician's prediction of survival and (ii) physician's prediction of survival time with actual survival. Factors associated with accurate prognostic awareness were identified by univariate analysis. RESULTS Of the 133 patients eligible for the study, 57 patients were analyzed. Only 10 (17.5%) patients had accurate prognostic awareness. Forty-three patients (75.4%) were optimistic about their prognosis; >80% of patients were more optimistic than their physicians about their prognosis. The physicians' predictions were accurate in for patients (37.5%). Accurate prognostic awareness was associated with physician's explanation of the prognosis and patients' perception of a good death. CONCLUSIONS A majority of the patients with advanced cancer in this study had prognostic awareness that was more optimistic in comparison with their actual survival, and most were more optimistic than their physicians about their prognosis. Further research is needed to develop programs to facilitate the discussion of life expectancy with patients in a manner that is consistent with their preferences.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.,Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Oishi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan.,Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Jennifer W Mack
- Department of Pediatric Oncology and Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hiroo Imai
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan.,Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Mori
- Department of Medical Oncology and Hematology, Okinawa Chubu Hospital, Uruma, Japan
| | - Masato Sakayori
- Department of Internal Medicine, Sodegaura Satsukidai Hospital, Sodegaura, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Chikashi Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan.,Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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14
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Miyashita J, Shimizu S, Shiraishi R, Mori M, Okawa K, Aita K, Mitsuoka S, Nishikawa M, Kizawa Y, Morita T, Fukuhara S, Ishibashi Y, Shimada C, Norisue Y, Ogino M, Higuchi N, Yamagishi A, Miura Y, Yamamoto Y. Culturally Adapted Consensus Definition and Action Guideline: Japan's Advance Care Planning. J Pain Symptom Manage 2022; 64:602-613. [PMID: 36115500 DOI: 10.1016/j.jpainsymman.2022.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT A conceptual framework for advance care planning is lacking in societies like Japan's valuing family-centered decision-making. OBJECTIVES A consensus definition of advance care planning with action guideline adapted to Japanese society. METHODS We conducted a multidisciplinary modified Delphi study 2020-2022. Thirty physicians, 10 healthcare and bioethics researchers, six nurses, three patient care managers, three medical social workers, three law experts, and a chaplain evaluated, in 7 rounds (including two web-based surveys where the consensus level was defined as ratings by ≥70% of panelists of 7-9 on a nine-point Likert scale), brief sentences delineating the definition, scope, subjects, and action guideline for advance care planning in Japan. RESULTS The resulting 29-item set attained the target consensus level, with 72%-96% of item ratings 7-9. Advance care planning was defined as "an individual's thinking about and discussing with their family and other people close to them, with the support as necessary of healthcare providers who have established a trusting relationship with them, preparations for the future, including the way of life and medical treatment and care that they wish to have in the future." This definition/action guideline specifically included support for individuals hesitant to express opinions to develop and express preparations for the future. CONCLUSION Adaptation of advance care planning to Japanese culture by consciously enhancing and supporting individuals' autonomous decision-making may facilitate its spread and establishment in Japan and other societies with family-centered decision-making cultures.
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Affiliation(s)
- Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University.
| | - Sayaka Shimizu
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University
| | - Ryuto Shiraishi
- Department of Palliative Medicine, Kobe University School of Medicine
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital
| | | | - Kaoruko Aita
- Uehiro Division for Death & Life Studies and Practical Ethics, The University of Tokyo
| | | | - Mitsunori Nishikawa
- Department of Palliative Care, National Center for Geriatrics and Gerontology
| | | | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University; Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | | | - Chiho Shimada
- Faculty of Humanities and Social Science, Saku University
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Mieko Ogino
- Department of Neurology, Ichikawa Hospital, International University of Health and Welfare
| | | | - Akemi Yamagishi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University
| | - Yasuhiko Miura
- Department of General Medicine, The Jikei University School of Medicine
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University
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15
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Patil CR, Tanawade P, Dhamne N, Anap Y, Watve P. “PALLCARE Seva”—A Beacon Amid the Catastrophic COVID-19 Times: A Cross-Sectional Study from a Rural Oncology Institute in Western Maharashtra. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1754371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Introduction Advanced cancer patients often require clinic or hospital follow-up for their symptom control to maintain their quality of life. But it becomes difficult for the patients to attend the same due to financial, commutation, and logistic issues.
Objective The aim of this study was to audit the telephonic calls of the service and prospectively collected data to understand the quality of service provided to the patients at follow-up.
Materials and Methods An ambispective observational study was conducted on the advanced stage cancer patients referred to the palliative care department at Kolhapur Cancer Center, Kolhapur, Maharashtra. We conducted an audit of the 523 telephonic calls of our service—“PALLCARE Seva” from June 2020 to February 2021. Prospectively, we assessed the quality of service based on 125 telephonic calls (n = 125) for this; we designed a questionnaire consisting of 11 items on the 5-point Likert scale for satisfaction by the patients or their caregivers at the follow-up. After a pilot study, the final format of questionnaire was used to collect the data.
Results Of the 523 calls attended, we provided 30.11% patients with dosage change of medications for their symptom management, 16.25% patients have liaised with local general practitioners, and 14.34% of cases had to be referred for emergency management to our hospitals. We provided 23.9% of them with emotional and bereavement support and 6.21% with smartphone-based or video-assisted guidance to the patients and caregivers.
Conclusions Liaison of general practitioners was possible in more than one-tenth of cases. The core components of our service were politeness and caring attitude, helpfulness, handling doubts regarding the illness, and an opportunity to share thoughts from the patients or caregivers. More than three-fourth of the callers have rated their experience as satisfactory and would recommend this service to other patients in need.
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Affiliation(s)
- Chaitanya R. Patil
- Department of Pain and Palliative Care, Kolhapur Cancer Center, Kolhapur, Maharashtra, India
| | - Prasad Tanawade
- Department of Radiation Oncology, Kolhapur Cancer Center, Kolhapur, Maharashtra, India
| | - Nilesh Dhamne
- Department of Medical Oncology, Kolhapur Cancer Center, Kolhapur, Maharashtra, India
| | - Yogesh Anap
- Department of Radiation Oncology, Kolhapur Cancer Center, Kolhapur, Maharashtra, India
| | - Parag Watve
- Department of Head and Neck Surgery, Kolhapur Cancer Center, Kolhapur, Maharashtra, India
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16
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Sato A, Fujimori M, Shirai Y, Umezawa S, Mori M, Jinno S, Umehashi M, Okamura M, Okusaka T, Majima Y, Miyake S, Uchitomi Y. Assessing the need for a question prompt list that encourages end-of-life discussions between patients with advanced cancer and their physicians: A focus group interview study. Palliat Support Care 2022; 20:564-569. [PMID: 35876449 DOI: 10.1017/s1478951521001796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Early integration of palliative and cancer care improves the quality of life and is facilitated by discussions about the end of life after cessation of active cancer treatment between patients with advanced cancer and their physicians. However, both patients and physicians find end-of-life discussions challenging. The aim of this study was to assess the need for a question prompt list (QPL) that encourages end-of-life discussions between patients with advanced cancer and their physicians. METHODS Focus group interviews (FGIs) were conducted with 18 participants comprising 5 pancreatic cancer patients, 3 family caregivers, 4 bereaved family members, and 6 physicians. Three themes were discussed: question items that should be included in the QPL that encourages end-of-life discussions with patients, family caregivers, and physicians after cessation of active cancer treatment; when the QPL should be provided; and who should provide the QPL. Each interview was audio-recorded, and content analysis was performed. RESULTS The following 9 categories, with 57 question items, emerged from the FGIs: (1) preparing for the end of life, (2) treatment decision-making, (3) current and future quality of life, (4) current and future symptom management, (5) information on the transition to palliative care services, (6) coping with cancer, (7) caregivers' role, (8) psychological care, and (9) continuity of cancer care. Participants felt that the physician in charge of the patient's care and other medical staff should provide the QPL early during active cancer treatment. SIGNIFICANCE OF RESULTS Data were collected to develop a QPL that encourages end-of-life discussions between patients with advanced cancer and their physicians.
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Affiliation(s)
- Ayako Sato
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
- Tokyo Medical and Dental University, Tokyo, Japan
| | - Maiko Fujimori
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Yuki Shirai
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Masanori Mori
- Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sayaka Jinno
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Mihoto Umehashi
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Masako Okamura
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
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17
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Bhadelia A, Oldfield LE, Cruz JL, Singh R, Finkelstein EA. Identifying Core Domains to Assess the "Quality of Death": A Scoping Review. J Pain Symptom Manage 2022; 63:e365-e386. [PMID: 34896278 DOI: 10.1016/j.jpainsymman.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023]
Abstract
CONTEXT There is growing recognition of the value to patients, families, society, and health systems in providing healthcare, including end-of-life care, that is consistent with both patient preferences and clinical guidelines. OBJECTIVES Identify the core domains and subdomains that can be used to evaluate the performance of end-of-life care within and across health systems. METHODS PubMed/MEDLINE (NCBI), PsycINFO (ProQuest), and CINAHL (EBSCO) databases were searched for peer-reviewed journal articles published prior to February 22, 2020. The SPIDER tool was used to determine search terms. A priori criteria were followed with independent review to identify relevant articles. RESULTS A total of 309 eligible articles were identified out of 2728 discrete results. The articles represent perspectives from the broader health system (11), patients (70), family and informal caregivers (65), healthcare professionals (43), multiple viewpoints (110), and others (10). The most common condition of focus was cancer (103) and the majority (245) of the studies concentrated on high-income country contexts. The review identified five domains and 11 subdomains focused on structural factors relevant to end-of-life care at the broader health system level, and two domains and 22 subdomains focused on experiential aspects of end-of-life care from the patient and family perspectives. The structural health system domains were: 1) stewardship and governance, 2) resource generation, 3) financing and financial protection, 4) service provision, and 5) access to care. The experiential domains were: 1) quality of care, and 2) quality of communication. CONCLUSION The review affirms the need for a people-centered approach to managing the delicate process and period of accepting and preparing for the end of life. The identified structural and experiential factors pertinent to the "quality of death" will prove invaluable for future efforts aimed to quantify health system performance in the end-of-life period.
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Affiliation(s)
- Afsan Bhadelia
- Department of Global Health and Population (A.B.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | | | - Jennifer L Cruz
- Department of Social and Behavioral Sciences (J.L.C.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ratna Singh
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
| | - Eric A Finkelstein
- Lien Centre for Palliative Care (R.S., E.A.F.), Duke-NUS Medical School, Singapore, Singapore
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18
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Amano K, Satomi E, Oyamada S, Ishiki H, Sakashita A, Miura T, Maeda I, Hatano Y, Yamauchi T, Oya K, Nakagawa J, Hiratsuka Y, Hirohashi T, Morita T, Mori M, Inoue S, Yokomichi N, Imai K, Tsukuura H, Naito AS, Uneno Y, Yoshioka A, Hiramoto S, Kikuchi A, Hori T, Matsuda Y, Kohara H, Funaki H, Tanaka K, Suzuki K, Kamei T, Azuma Y, Uno T, Miyamoto J, Katayama H, Kashiwagi H, Matsumoto E, Yamaguchi T, Okamura T, Hashimoto H, Kosugi S, Ikuta N, Matsumoto Y, Ohmori T, Nakai T, Ikee T, Unoki Y, Kitade K, Koito S, Ishibashi N, Ehara M, Kuwahara K, Ueno S, Nakashima S, Ishiyama Y, Matsunuma R, Takatsu H, Yamaguchi T, Ito S, Terabayashi T, Yamagiwa T, Inoue A, Yamaguchi T, Miyashita M, Yoshida S, Tagami K, Watanabe H, Odagiri T, Ito T, Ikenaga M, Shimizu K, Hayakawa A, Kamura R, Okoshi T, Nishi T, Kosugi K, Shibata Y, Hisanaga T, Higashibata T, Yabuki R, Hagiwara S, Shimokawa M, Miyake S, Nozato J, Iriyama T, Kaneishi K, Baba M, Matsumoto Y, Okizaki A, Sumazaki Watanabe Y, uehara Y, Nishijima K, Shimoinaba J, Nakahori R, Hamano J, Kawashima N, Kawaguchi T, Uchida M, Sato K, Matsuda Y, Tsuneto S, Maeda S, Kizawa Y, Otani H. The prevalence of artificially administered nutrition and hydration in different age groups among patients with advanced cancer admitted to palliative care units. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Chikada A, Takenouchi S, Nin K, Mori M. Definition and Recommended Cultural Considerations for Advance Care Planning in Japan: A Systematic Review. Asia Pac J Oncol Nurs 2021; 8:628-638. [PMID: 34790847 PMCID: PMC8522591 DOI: 10.4103/apjon.apjon-2137] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022] Open
Abstract
Although Delphi studies in Western countries have provided a consensus for practices pertaining to advance care planning (ACP), their findings may not be applicable to Asian countries with distinct, family-oriented cultures. This systematic review aimed to synthesize the definitions of and evidence for ACP and analyze recommended practices in Japan. We conducted a systematic review using narrative synthesis in December 2018. Key words were searched from Ichushi-Web by NPO Japan Medical Abstracts Society, Citation Information by the National Institute of Informatics, and Japanese Institutional Repositories Online databases. In addition, in August 2019, we conducted hand searching using Google Scholar and Google. We included original Japanese articles that addressed factors regarding ACP (e.g. definitions, elements, roles and tasks, and timing of ACP). Data were synthesized using thematic analysis. The study protocol was registered prospectively (PROSPERO: CRD42020152391). Of the 3,512 studies screened, 27 were included: 22 quantitative and 5 qualitative. Five-position statements/guidelines were added by hand searching. Definitions and several distinct practice patterns of ACP and the importance of families' roles were identified. Unique recommendations addressed the importance of properly eliciting patients' preferences that are the best for both patients and families, engaging the public to raise awareness of ACP, and developing policies and guidelines for ACP. We identified the definition of and unique recommendations for ACP based on Japanese cultural values and norms. Further research is needed to evaluate the recommendations provided in this systematic review.
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Affiliation(s)
- Ai Chikada
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Takenouchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuko Nin
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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20
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Gillespie J, Przybylak-Brouillard A, Watt CL. The Palliative Care Information Needs of Patients with Amyotrophic Lateral Sclerosis and their Informal Caregivers: A Scoping Review. J Pain Symptom Manage 2021; 62:848-862. [PMID: 33757892 DOI: 10.1016/j.jpainsymman.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease, associated with impaired quality of life for patients and caregivers. As treatment is largely supportive, early involvement of palliative care (PC) is recommended as standard of care. Despite this, literature surrounding PC information needs is limited. OBJECTIVES To explore the PC information needs of patients with ALS and their caregivers and identify gaps in the literature. METHODS A scoping review using MEDLINE, EMBASE, CINAHL and PsycINFO databases (2000-2019) was conducted. Articles examining PC information needs as stated by ALS patients and/or current/bereaved caregivers were included. Studies examining other diagnoses and those focused on healthcare workers were excluded. Thematic synthesis was used to summarize and identify prevalent domains and themes in the literature. RESULTS 581 articles underwent primary screening, with thirty-two ultimately included (26 original articles, six reviews). Fourteen examined information needs of both patients and caregivers, 13 caregivers only, 5 patients only. The most common PC information needs were as follows: for patients, disease course/prognosis (n = 10), general disease information (n = 9), decision-making (n = 7) and symptoms (n = 6); for caregivers, services and resources (n = 15), disease course/prognosis (n = 14), general disease information (n = 13) and skills (n = 10). There was substantial variability in information needs, both between patients and caregivers and among members of the same group. CONCLUSION ALS patients and caregivers have unique and varying PC information needs. Future research should better characterize these needs to improve patient and caregiver quality of life. The delivery of information must be tailored to individual patient or caregiver preferences.
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Affiliation(s)
- Jacqueline Gillespie
- Division of Palliative Care, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Christine L Watt
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyere Research Institute, Ottawa, Ontario, Canada.
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21
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Arraras JI, Giesinger J, Shamieh O, Bahar I, Koller M, Bredart A, Kuljanic K, Costantini A, Greimel E, Sztankay M, Wintner LM, Carreiro de Sousa M, Ishiki H, Kontogianni M, Wolan M, Kikawa Y, Lanceley A, Gioulbasanis I, Harle A, Kuliś D. Cancer patient satisfaction with health care professional communication: An international EORTC study. Psychooncology 2021; 31:541-547. [PMID: 34546631 DOI: 10.1002/pon.5823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Affiliation(s)
| | - Johannes Giesinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | - Iqbal Bahar
- Head, Pain and Palliative Medicine, Cachar Cancer hospital and Research Centre, Silchar, India
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Anne Bredart
- Psycho-Oncology Unit, Institut Curie, Paris, France.,Psychopathology and Health Process LaboratoryUR4057, Paris University, Paris, France
| | - Karin Kuljanic
- Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Anna Costantini
- Psychoncology Unit, Sant'Andrea Universitary Hospital, Rome, Italy
| | - Eva Greimel
- Department of Obstetrics and Gynecology, Medical University Graz, Graz, Austria
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Lisa M Wintner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina Carreiro de Sousa
- Department of Psychology, Faculty of Human and Social Sciences, University of the Azores, Ponta Delgada, Portugal.,Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Meropi Kontogianni
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Maja Wolan
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Anne Lanceley
- Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Ioannis Gioulbasanis
- Department of Medical Oncology, Animus Kyanus Stavros General Clinic, Larissa, Greece
| | - Amelie Harle
- Dorset Cancer Centre, University Hospitals Dorset, Poole, UK
| | - Dagmara Kuliś
- Quality of Life Department, European Organisation or Research and Treatment of Cancer, Brussels, Belgium
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22
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Anzai T, Sato T, Fukumoto Y, Izumi C, Kizawa Y, Koga M, Nishimura K, Ohishi M, Sakashita A, Sakata Y, Shiga T, Takeishi Y, Yasuda S, Yamamoto K, Abe T, Akaho R, Hamatani Y, Hosoda H, Ishimori N, Kato M, Kinugasa Y, Kubozono T, Nagai T, Oishi S, Okada K, Shibata T, Suzuki A, Suzuki T, Takagi M, Takada Y, Tsuruga K, Yoshihisa A, Yumino D, Fukuda K, Kihara Y, Saito Y, Sawa Y, Tsutsui H, Kimura T. JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases. Circ J 2021; 85:695-757. [PMID: 33775980 DOI: 10.1253/circj.cj-20-1127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takuma Sato
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, Chikamori Hospital
| | - Naoki Ishimori
- Department of Community Heart Failure Healthcare and Pharmacy, Hokkaido University Graduate School of Medicine
| | - Mika Kato
- Nursing Department, Hokkaido University Hospital
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shogo Oishi
- Department of Cardiovascular Medicine, Hyogo Brain and Heart Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Masahito Takagi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuko Takada
- Nursing Department, National Cerebral and Cardiovascular Center
| | | | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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23
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Chikada A, Takenouchi S, Arakawa Y, Nin K. A descriptive analysis of end-of-life discussions for high-grade glioma patients. Neurooncol Pract 2021; 8:345-354. [PMID: 34061125 DOI: 10.1093/nop/npab010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. Methods A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher's exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. Results In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient's wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. Conclusions Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.
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Affiliation(s)
- Ai Chikada
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Takenouchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuko Nin
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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24
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Chikada A, Takenouchi S, Nin K, Mori M. Definition and recommended cultural considerations for advance care planning in Japan: A systematic review. Asia Pac J Oncol Nurs 2021. [DOI: 10.4103/apjon.apjon_2137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Cheng SY, Lin CP, Chan HYL, Martina D, Mori M, Kim SH, Ng R. Advance care planning in Asian culture. Jpn J Clin Oncol 2020; 50:976-989. [PMID: 32761078 DOI: 10.1093/jjco/hyaa131] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 07/20/2020] [Indexed: 11/14/2022] Open
Abstract
Ageing has been recognized as one of the most critically important health-care issues worldwide. It is relevant to Asia, where the increasing number of older populations has drawn attention to the paramount need for health-care investment, particularly in end-of-life care. The advocacy of advance care planning is a mean to honor patient autonomy. Since most East Asian countries are influenced by Confucianism and the concept of 'filial piety,' patient autonomy is consequently subordinate to family values and physician authority. The dominance from family members and physicians during a patient's end-of-life decision-making is recognized as a cultural feature in Asia. Physicians often disclose the patient's poor prognosis and corresponding treatment options to the male, family member rather to the patient him/herself. In order to address this ethical and practical dilemma, the concept of 'relational autonomy' and the collectivism paradigm might be ideally used to assist Asian people, especially older adults, to share their preferences on future care and decision-making on certain clinical situations with their families and important others. In this review article, we invited experts in end-of-life care from Hong Kong, Indonesia, Japan, South Korea, Singapore and Taiwan to briefly report the current status of advance care planning in each country from policy, legal and clinical perspectives. According to the Asian experiences, we have seen different models of advance care planning implementation. The Asian Delphi Taskforce for advance care planning is currently undertaken by six Asian countries and a more detailed, culturally sensitive whitepaper will be published in the near future.
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Affiliation(s)
- Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Cheng-Pei Lin
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Central Ave, Hong Kong
| | - Diah Martina
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine Universitas Indonesia, Jakarta Pusat, Indonesia
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sun-Hyun Kim
- Department of Family Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Republic of Korea
| | - Raymond Ng
- Department of Palliative Medicine, Tan Tock Seng Hospital, Jln Tan Tock Seng, Singapore
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26
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Fujimori M, Sato A, Jinno S, Okusaka T, Yamaguchi T, Ikeda M, Ueno M, Ozaka M, Takayama Y, Miyaji T, Majima Y, Uchitomi Y. Integrated communication support program for oncologists, caregivers and patients with rapidly progressing advanced cancer to promote patient-centered communication: J-SUPPORT 1904 study protocol for a randomised controlled trial. BMJ Open 2020; 10:e036745. [PMID: 32967874 PMCID: PMC7513597 DOI: 10.1136/bmjopen-2019-036745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Communication is an essential aspect of care for patients with progressive serious illnesses. This study aims to evaluate the efficacy of a new, integrated communication support program for oncologists, patients with rapidly progressing advanced cancer and their caregivers. METHODS AND ANALYSIS The proposed integrated communication support programme is in the randomised control trial stage. It comprises a cluster of oncologists from comprehensive cancer centre hospitals in a metropolitan area in Japan. A total of 20 oncologists, 200 patients with advanced pancreatic cancer and the patients' caregivers are enrolled in this study as of the writing of this protocol report. Oncologists are randomly assigned to the intervention group (IG) or control group (CG). Patients and caregivers are allocated to the same group as their oncologists. The IG oncologists receive a 2.5-hour individual communication skills training, and patients and caregivers receive a half-hour coaching intervention to facilitate prioritising and discussing questions and concerns; the CG participants do not receive any training. Follow-up data will be collected quarterly for 6 months for a year and then annually for up to 3 years. The primary endpoint is the intergroup difference between before-intervention and after-intervention patient-centred communication behaviours during oncology visits. ETHICS AND DISSEMINATION This study is conducted in accordance with the ethical guidelines for clinical studies published by Japan's Ministry of Education, Cultural, Sports, Science and Technology, the Ministry of Health, Labour and Welfare, and the ethical principles established for research on humans stipulated in the Declaration of Helsinki and further amendments thereto. The protocol was approved by the Institutional Review Board of National Cancer Center, Japan on 4 July 2018 (ID: 2017-474). TRIAL STATUS This study is currently enrolling participants. Enrolment period ends 31 July 2020; estimated follow-up date is 31 March 2023. TRIAL REGISTRATION NUMBER UMIN Clinical Trial Registry (UMIN000033612); pre-results.
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Affiliation(s)
- Maiko Fujimori
- Division of Behavioral Science and Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Ayako Sato
- Division of Behavioral Science and Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Sayaka Jinno
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Takuji Okusaka
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Chuo-ku, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine Department of Medical Biochemistry, Sendai, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary Pancreatic Oncology, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan
| | - Masato Ozaka
- Department of Hepatobiliary and Pancreatic Medical Oncology, Public Interest Incorporated Foundation Cancer Institute Hospital of JFCR, Koto-ku, Japan
| | - Yukiko Takayama
- Department of Medicine, Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Shinjuku-ku, Japan
| | - Tempei Miyaji
- Department of Clinical Trial Data Management, Tokyo University Graduate School of Medicine, Bunkyo-ku, Japan
| | | | - Yosuke Uchitomi
- Division of Behavioral Science and Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Chuo-ku, Japan
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27
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Tsuboi R, Sugishita M, Hirakawa Y, Ando Y. Experiences and hidden needs of older patients, their families and their physicians in palliative chemotherapy decision-making: a qualitative study. Jpn J Clin Oncol 2020; 50:779-786. [PMID: 32280959 DOI: 10.1093/jjco/hyaa020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE This study aimed to clarify the experiences and hidden needs of older patients with advanced cancer, their families and their physicians in palliative chemotherapy decision-making. MATERIALS AND METHODS We conducted in-depth qualitative individual interviews with content analysis. Patients who were diagnosed as having advanced cancer, were aged ≥70 years (n = 15, median [range] = 77 [70-82] years) and had volunteered to receive palliative chemotherapy within the past 6 months were enrolled. Their families and physicians were also interviewed. RESULTS The following four themes were identified: (i) physician's awareness of paternalism; (ii) readiness for communication of serious news; (iii) spiritual care need assessment and (iv) support as a team. The patients and families expected physicians to demonstrate paternalism in their decision-making because they were unconfident about their self-determination capability. Although the physicians were aware of this expectation, they encountered difficulties in recommending treatment and communicating with older patients. The patients had spiritual pain since the time of diagnosis. Psychological issues were rarely discussed during decision-making and treatment, triggering feelings of isolation in the patients and their families. CONCLUSION Older patients and their families expected a paternalistic approach by the physicians for palliative chemotherapy decision-making. The physicians found it difficult to offer treatment options because of older patient diversity and limitations in evidence-based strategies. Therefore multidisciplinary approaches and evidence-based decision support aids are warranted. Because older patients and their families often have unexpressed psychological burdens including unmet spiritual needs, medical professionals should provide psychological care from the time of diagnosis.
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Affiliation(s)
- Rie Tsuboi
- Department of Clinical oncology and Chemotherapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mihoko Sugishita
- Department of Clinical oncology and Chemotherapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Ando
- Department of Clinical oncology and Chemotherapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
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28
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Miyashita J, Kohno A, Cheng SY, Hsu SH, Yamamoto Y, Shimizu S, Huang WS, Kashiwazaki M, Kamihiro N, Okawa K, Fujisaki M, Tsai JS, Fukuhara S. Patients' preferences and factors influencing initial advance care planning discussions' timing: A cross-cultural mixed-methods study. Palliat Med 2020; 34:906-916. [PMID: 32356489 DOI: 10.1177/0269216320914791] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain. AIM To evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan. DESIGN Mixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing. SETTING/PARTICIPANTS Patients aged 40-75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited. RESULTS Overall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan (p < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers' initiative. CONCLUSION The majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients' preferences and factors associated with acceptance and reluctance to initiate advance care planning.
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Affiliation(s)
- Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ayako Kohno
- Department of Health Informatics, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Su-Hsuan Hsu
- Department of Family Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Wei-Sheng Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | | | - Noriki Kamihiro
- The Kansai Centre for Family Medicine, Kanai Hospital, Kyoto, Japan
| | - Kaoru Okawa
- Department of Home Care Medicine, Kameda Medical Center, Chiba, Japan
| | - Masami Fujisaki
- Department of General Medicine, Medical Center Narita Hospital, Chiba, Japan
| | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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29
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Communication Needs of Cancer Patients and/or Caregivers: A Critical Literature Review. JOURNAL OF ONCOLOGY 2020; 2020:7432849. [PMID: 32454826 PMCID: PMC7229568 DOI: 10.1155/2020/7432849] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/13/2020] [Accepted: 04/21/2020] [Indexed: 12/30/2022]
Abstract
Objective Effective communication for cancer patients and/or caregivers can meet information needs, reduce caregiver burden, improve physical and mental health, and promote intimacy. The aim of this review was to identify the communication needs of cancer patients and/or caregivers and to explore their specific communication needs to guide the development of future communication interventions. Methods Chinese and English databases were systematically searched from January 2010 to October 2019, including MEDLINE, CINAHL, PubMed, and the China Academic Journal Full-text Database. The key search terms used were “cancer” or “carcinoma” or “oncology” AND “patient” or “caregiver” or “carer” AND “communication” or “discussion” or “talk” AND “need” or “needs” or “desire.”. Results A total of 26 articles was identified and included in this review. The findings revealed the needs of cancer patients and/or caregivers in terms of communication target, content, style, timing, and preferences. Communication targets included health professionals, peers, caregivers, and patients. Communication content included illness-related, emotional support, daily life, sexuality, death, and a way to communicate with health professionals. Communication style needed to be expressed through such things as language and communication atmosphere. Communication timing mainly referred to before treatment and approaching death. Communication preferences were related to factors such as demographics and ethnic origin. Conclusions Cancer patients and/or caregivers have different communication needs in terms of target, content, style, and communication timing. A better understanding of the unique communication needs of patients and/or caregivers will offer health professionals detailed information on designing appropriate interventions to support cancer patients and caregivers.
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30
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Sisk BA, Dobrozsi S, Mack JW. Teamwork in prognostic communication: Addressing bottlenecks and barriers. Pediatr Blood Cancer 2020; 67:e28192. [PMID: 31965719 PMCID: PMC7096274 DOI: 10.1002/pbc.28192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/16/2019] [Accepted: 01/09/2020] [Indexed: 11/09/2022]
Abstract
Prognostic communication is essential to family-centered care in pediatric oncology. Yet, prognostic communication from the medical team to the family is often absent or incomplete. In our experience, many clinical groups view prognostic disclosure as the responsibility of the patient's primary oncologist, and nurses are often excluded from these conversations. This current individual-based model of prognostic disclosure lacks redundancy and creates a communication bottleneck. We propose that clinical groups should address prognostic communication with a multidisciplinary team-based approach that incorporates three critical components: shared team mental models, distribution and redundancy in role assignment, and high fidelity monitoring of communication milestones.
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Affiliation(s)
- Bryan A. Sisk
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Sarah Dobrozsi
- Division of Hematology and Oncology, Department of Pediatrics, Medical College of Wisconsin/Children’s Hospital of Wisconsin, Milwaukee, WI, USA
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; and Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
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Mori M, Fujimori M, van Vliet LM, Yamaguchi T, Shimizu C, Kinoshita T, Morishita-Kawahara M, Inoue A, Inoguchi H, Matsuoka Y, Bruera E, Morita T, Uchitomi Y. Explicit prognostic disclosure to Asian women with breast cancer: A randomized, scripted video-vignette study (J-SUPPORT1601). Cancer 2019; 125:3320-3329. [PMID: 31206639 DOI: 10.1002/cncr.32327] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/31/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nondisclosure of a poor prognosis to patients with advanced cancer remains a typical practice in Asia. Although the importance of prognostic communication has increasingly been recognized worldwide, little is known about whether explicit prognostic disclosure positively affects Asian patients with advanced cancer. The objective of this study was to examine the effects of explicit prognostic communication on patients with cancer recurrence. METHODS In this randomized, video-vignette study, Japanese women with breast cancer who had undergone curative surgery viewed videos of prognostic communication between a patient with recurrent, incurable breast cancer and her oncologist. The videos differed only in the presence or absence of explicit prognostic disclosure. The primary outcome was participants' uncertainty (rated from 0 to 10), and the secondary outcomes included anxiety (measured on the State-Trait Anxiety Inventory-State: range, 20-80), satisfaction (Patient Satisfaction Questionnaire; range 0-10), self-efficacy (range, 0-10), and willingness to discuss advance care planning (range, 1-4). RESULTS In total, 105 women participated (mean ± SD age, 53.8 ± 8.2 years). After viewing the video with more versus less explicit disclosure, participants showed significantly lower uncertainty (mean ± SE scores, 5.3 ±0.2 vs 5.7 ± 0.2, respectively; P = .032) and higher satisfaction (5.6 ± 0.2 vs 5.2 ± 0.2, respectively; P = .010) without increasing anxiety (changes in scores on the State-Trait Anxiety Inventory-State: 0.06 ± 0.5 vs 0.6 ± 0.5, respectively; P = .198). No significant differences were observed in self-efficacy (5.2 ± 0.2 vs 5.0 ± 0.2, respectively; P = .277) or willingness to discuss advance care planning (2.7 ± 0.1 vs 2.7 ± 0.1, respectively; P = .240). CONCLUSIONS Explicit prognostic disclosure prompted better outcomes than nondisclosure in Japanese women with breast cancer. When asked about the prognosis by Asian patients with cancer, clinicians may be encouraged to respect their wishes and explicitly discuss the prognosis if deemed appropriate.
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Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan.,Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Maiko Fujimori
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Division of Cohort Consortium Research, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Liesbeth M van Vliet
- Department of Communication, Nivel-Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Department of Health, Medical, and Neuropsychology, Leiden University, Leiden, Netherlands
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chikako Shimizu
- Department of Breast Medical Oncology, National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Miki Morishita-Kawahara
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Hironobu Inoguchi
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Matsuoka
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yosuke Uchitomi
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Innovation Center for Supportive, Palliative, and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
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Mori M, Fujimori M, Ishiki H, Nishi T, Hamano J, Otani H, Uneno Y, Oba A, Morita T, Uchitomi Y. The Effects of Adding Reassurance Statements: Cancer Patients' Preferences for Phrases in End-of-Life Discussions. J Pain Symptom Manage 2019; 57:1121-1129. [PMID: 30818028 DOI: 10.1016/j.jpainsymman.2019.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/23/2022]
Abstract
CONTEXT When discussing end-of-life issues with cancer patients, the addition of reassurance statements is considered helpful. However, patients' preferences for such statements have not been systematically demonstrated. OBJECTIVES The objectives of this study were to clarify if phrases with additional reassurance statements would be more preferable to phrases without them and explore variables associated with patients' preferences. METHODS In a cross-sectional survey, 412 cancer patients assessed their own preferences for phrases with/without additional statements using a six-point scale (1 = not at all preferable; 6 = very preferable). These included the statements of "hope for the best and prepare for the worst" ("hope/prepare") when discussing prognosis; symptom palliation when discussing code status; and specific goals, continuity of care, and nonabandonment when discussing hospice referral. We evaluated demographic data and the coping style and conducted multivariate regression analysis. RESULTS Compared with the phrase of life expectancy (i.e., median + typical range) alone [mean (SD), 3.5 (1.2); 95% CI, 3.4-3.6], the phrase with the additional "hope/prepare" statement was more preferable [3.8 (1.4); 3.7-3.9]. Compared with the phrase of do-not-resuscitate alone (3.1(1.3); 3.0-3.3), the phrase with the additional statement of symptom palliation was more preferable [3.9 (1.3); 3.7-4.0]. Compared with the phrase of hospice referral alone [3.4 (1.2); 3.3-3.5], phrases with the addition of a specific goal [3.9 (1.0); 3.8-4.0], specific goal and continuity (4.4(1.0); 4.3-4.5), and specific goal, continuity, and nonabandonment [4.8 (1.2); 4.7-4.9] were more preferable. In multivariate analyses, task-oriented coping was significantly correlated with preferences for phrases including additional reassurance statements. CONCLUSION Cancer patients systematically preferred reassurance statements. In end-of-life discussions, especially with patients with task-oriented coping, clinicians may provide additional reassurance statements.
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Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Division of Health Care Research, QOL Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
| | - Maiko Fujimori
- Division of Health Care Research, QOL Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Division of Cohort Consortium Research, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center, Tokyo, Japan
| | - Tomohiro Nishi
- Kawasaki Comprehensive Care Center, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroyuki Otani
- Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akira Oba
- Patient Support Center, Gunma Prefectural Cancer Center, Ota, Gunma, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yosuke Uchitomi
- Division of Cohort Consortium Research, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
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Sisk BA, Canavera K, Sharma A, Baker JN, Johnson LM. Ethical issues in the care of adolescent and young adult oncology patients. Pediatr Blood Cancer 2019; 66:e27608. [PMID: 30623573 DOI: 10.1002/pbc.27608] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 12/12/2022]
Abstract
The diagnosis and treatment of cancer leads to short-term and long-term challenges for every patient. This is especially true for adolescents and young adults (AYAs) with cancer who strive to gain independence, autonomy, confidence, and social status while developing into adulthood. In this article, we review prominent ethical issues in AYA oncology that are related to autonomy, shared decision-making, care refusal or abandonment, end-of-life care, truth telling, and fertility preservation. Clinicians should recognize that AYA patients develop at their own pace; the onus lies with clinicians to determine the patient's interests, values, maturity, and desire to participate in decision-making.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kristin Canavera
- Division of Psychology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Akshay Sharma
- Department of Bone Marrow Transplant and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N Baker
- Division of Quality-of-Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Liza-Marie Johnson
- Division of Quality-of-Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Mori M, Fujimori M, Ishiki H, Nishi T, Hamano J, Otani H, Uneno Y, Oba A, Morita T, Uchitomi Y. Adding a Wider Range and "Hope for the Best, and Prepare for the Worst" Statement: Preferences of Patients with Cancer for Prognostic Communication. Oncologist 2019; 24:e943-e952. [PMID: 30782978 DOI: 10.1634/theoncologist.2018-0643] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/09/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Although various phrases to communicate prognoses based on a certain concept have been proposed, no study has systematically investigated preferences of patients with cancer for actual phrases. We investigated whether phrases with a wider range and additional "hope for the best, and prepare for the worst" (hope/prepare) statement would be more preferable and explored variables associated with patients' preferences. MATERIALS AND METHODS In a cross-sectional survey, 412 outpatients with cancer self-assessed their preferences for 13 phrases conveying prognostic information (e.g., phrases with or without median, typical range, and/or best/worst cases, and those with or without a hope/prepare statement) on a 6-point scale (1 = not at all preferable; 6 = very preferable). We evaluated demographic data and the Coping Inventory for Stressful Situations and conducted multivariate regression analysis. RESULTS Regarding phrases with various ranges, the one including the median, typical range, and best/worst cases was more preferable (mean ± SD, 3.8 ± 1.3; 95% confidence interval [CI], 3.6-3.9) than the one with the median and typical range (3.4 ± 1.2; 3.3-3.6) or the one with only the median (3.2 ± 1.3; 3.1-3.3). Concerning the hope/prepare statement, the phrase including the median, typical range, uncertainty, and hope/prepare statement was more preferable (3.8 ± 1.4; 3.7-3.9) than the one without the statement (3.5 ± 1.2; 3.4-3.6). In multivariate analyses, task-oriented coping was significantly correlated with preferences for phrases with explicit information. CONCLUSION Overall, phrases with a wider range and the hope/prepare statement were preferable to those without them. When patients with cancer ask about prognoses, especially those with task-oriented coping, clinicians may provide explicit information with a wider range and the hope/prepare statement. IMPLICATIONS FOR PRACTICE Discussing prognoses with patients with advanced cancer is among the most important conversations for clinicians. In this cross-sectional survey to systematically investigate preferences of 412 patients with cancer for phrases conveying prognostic information, phrases with the median, typical range, and best/worst cases and those with the "hope for the best and prepare for the worst" (hope/prepare) statement were the most preferred. When patients with cancer ask about prognoses, clinicians may provide explicit information with a wider range and include the hope/prepare statement.
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Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
- Division of Health Care Research, QOL Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Maiko Fujimori
- Division of Health Care Research, QOL Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
- Division of Cohort Consortium Research, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center, Tokyo, Japan
| | - Tomohiro Nishi
- Kawasaki Comprehensive Care Center, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Otani
- Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yu Uneno
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Oba
- Patient Support Center, Gunma Prefectural Cancer Center, Ota, Gunma, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yosuke Uchitomi
- Division of Cohort Consortium Research, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center, Tokyo, Japan
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35
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[The role of the family doctor in the palliative care of chronic and terminally ill patients]. Semergen 2019; 45:349-355. [PMID: 30718073 DOI: 10.1016/j.semerg.2018.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/28/2018] [Accepted: 09/24/2018] [Indexed: 12/19/2022]
Abstract
The objective of this work was to identify the role of family physicians in the care of patients and their families in the approach to the end of life. Nowadays, with the increase in the demand for care of patients with terminal illnesses, there is also evidence on the lack of physicians with the profile and skills to fulfil this coverage deficit. A review of the literature was carried out in five databases from January 2015 to May 2018, and concluded that family doctors, based on their professional skills, ability to engage with the patients, their families, and their performance in the coordination of medical resources, are in an ideal position to attend and solve complex problems of patients at the end of life. In the present review, the specific roles of family physicians in clinical and psychosocial areas, and also the difficulties in facing the challenges in the care of patients and families undergoing the end of life process are described.
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36
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Gilbar P. Shared decision making can aid the informed consent process for end-of-life chemotherapy in cancer patients. J Oncol Pharm Pract 2019; 25:249-250. [DOI: 10.1177/1078155218791346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Gilbar
- Toowoomba Hospital, PMB 2, Toowoomba, Queensland, Australia
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37
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What determines the timing of discussions on forgoing anticancer treatment? A national survey of medical oncologists. Support Care Cancer 2018; 27:1375-1382. [DOI: 10.1007/s00520-018-4423-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/13/2018] [Indexed: 11/27/2022]
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38
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Communicating terminal prognosis: The provider's role in reframing hope. Palliat Support Care 2018; 16:803-805. [DOI: 10.1017/s1478951518000329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Mackenzie LJ, Carey ML, Suzuki E, Sanson-Fisher RW, Asada H, Ogura M, D’Este C, Yoshimura M, Toi M. Agreement between patients' and radiation oncologists' cancer diagnosis and prognosis perceptions: A cross sectional study in Japan. PLoS One 2018; 13:e0198437. [PMID: 29883453 PMCID: PMC5993258 DOI: 10.1371/journal.pone.0198437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 05/18/2018] [Indexed: 12/01/2022] Open
Abstract
This study assessed agreement between radiation oncologist- and cancer patient-reported perceptions about cancer diagnosis, time since diagnosis, treatment purpose, and whether life expectancy had been discussed; and described preferences for prognosis discussions. Adult cancer patients receiving radiotherapy at a Japanese hospital were invited to complete a touchscreen tablet survey. Patient survey responses were linked and comparisons made with a survey completed by their radiation oncologist. Among 146 cancer patient-oncologist dyads, there was almost perfect agreement on cancer diagnosis (ĸ = 0.88, 95% CI: 0.82–0.94), substantial agreement on time since diagnosis (ĸ = 0.70, 95% CI: 0.57–0.83) and moderate agreement on whether treatment goal was curative or palliative (ĸ = 0.44, 95% CI: 0.28–0.57; all p’s < 0.0001). Agreement about whether a life expectancy discussion had occurred was less than expected by chance (κ = -0.06, p = 0.9). Radiation oncologists reported that they had spoken to over two thirds of patients about this, whilst less than one third of patients stated that this discussion had occurred with their radiation oncologist. Over half of the patients who had not discussed life expectancy wanted to. Patients had variable preferences for whether they (80%), their radiation oncologist (78%) or their partner/family (52%) should decide whether they discuss their life expectancy. Although patient self-reported information about diagnosis and time since diagnosis appears to be reasonably accurate (compared with clinician-reported information), limitations of self-reported data about prognostic discussions were highlighted by poor agreement between patient- and clinician-reported information about whether prognostic discussions have occurred. Additional support is needed to improve prognosis communication and understanding in radiation oncology settings.
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Affiliation(s)
- Lisa Jane Mackenzie
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan
- * E-mail:
| | - Mariko Leanne Carey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Eiji Suzuki
- Breast Surgery, Kyoto University Hospital, Kyoto, Japan
| | | | - Hiromi Asada
- Department of Nursing, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Ogura
- Department of Radiation Oncology and Image Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, Australian Capital Territory, Australia
| | - Michio Yoshimura
- Department of Radiation Oncology and Image Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Toi
- Breast Surgery, Kyoto University Hospital, Kyoto, Japan
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Collins A, McLachlan SA, Philip J. How should we talk about palliative care, death and dying? A qualitative study exploring perspectives from caregivers of people with advanced cancer. Palliat Med 2018; 32:861-869. [PMID: 29235421 DOI: 10.1177/0269216317746584] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health professionals commonly underestimate caregiver needs for information about palliative care, death and dying and may feel poorly prepared to discuss these issues. Few studies have sought caregiver perspectives of these communication practices. AIM To explore caregiver perspectives on communication about death, dying and the introduction to palliative care, with a view towards a series of caregiver-informed recommendations for use in clinical practice. DESIGN Cross-sectional, prospective, exploratory qualitative design, involving narrative-style interviews and underpinned by an interpretative phenomenological framework. SETTING/PARTICIPANTS Purposively sampled, English-speaking, adult caregivers of people with advanced cancer ( n = 25) recruited from cancer services at a tertiary metropolitan hospital in Melbourne, Australia. RESULTS Caregivers reported wanting routinely available written resources about palliative care, supplemented by conversations that are ideally staged overtime. Education about the tasks of palliative care should be separated from referral process, allowing time for gradual adjustment, and re-visiting discussion to enable patients and families to take some control in the process of transition. Once death is imminent, carers wanted health professionals to clarify how much they want to know about the dying process; provide spoken acknowledgement when death is close; include the words 'death' and 'dying'; use direct language, avoiding euphemisms; and communicate about death with patient present. CONCLUSION This study is among the first to directly address caregiver perspectives of communication about death, dying and the introduction to palliative care. The recommendations derived from caregiver perspectives build upon existing guidelines and offer health professionals some preliminary considerations around how to undertake these important communication tasks in future.
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Affiliation(s)
- Anna Collins
- 1 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,2 VCCC Palliative Medicine Research Group, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Sue-Anne McLachlan
- 1 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,3 Medical Oncology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Jennifer Philip
- 1 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,2 VCCC Palliative Medicine Research Group, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,4 Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
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Abstract
BACKGROUND Payment models for palliative care vary across nations, with few adopting contemporary payments designs that apply to other parts of the health system. AIM To propose optimal payment arrangements for palliative care. APPROACH Review of relevant literature on funding mechanisms in health care generally and palliative care in particular. RESULTS Payment models for palliative care should move toward activity-based funding using an agreed classification, be uncapped funding with performance monitoring, and make explicit use of performance metrics and reporting. CONCLUSIONS If palliative care is to become a universally accessible service, new approaches to funding, based on the experience of funding reforms in other parts of the health system, need to be adopted.
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Affiliation(s)
- Stephen Duckett
- Health Program, Grattan Institute, 8 Malvina Place, Carlton, VIC, 3053, Australia.
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Malhotra C, Xiang L, Ozdemir S, Kanesvaran R, Chan N, Finkelstein EA. A comparison of attitudes toward length and quality of life between community-dwelling older adults and patients with advanced cancer. Psychooncology 2017; 26:1611-1617. [PMID: 27943487 DOI: 10.1002/pon.4344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 11/01/2016] [Accepted: 12/05/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Applying prospect theory to end-of-life decision making, we hypothesize that community-dwelling older adults (CDOAs) will be relatively less inclined towards extending length over improving quality of life compared with patients. We also hypothesize that differences in relative inclination for length over quality of life between the 2 groups will decrease with advancing age. METHODS We tested these hypotheses by administering the quality-quantity questionnaire to 1067 CDOAs and 320 stage IV cancer patients and applying a linear regression model to assess whether relative inclination for length over quality of life, as estimated by the questionnaire, differed between CDOAs and patients after controlling for differences in sociodemographic characteristics. We also assessed the effect of interaction between age and participant status (CDOA compared to patient) on relative inclination for length over quality of life. RESULTS Consistent with prospect theory, a lower proportion of CDOAs (26%) than patients (42%) were relatively more inclined towards length over quality of life. Results were significant even after adjusting for differences in sociodemographics (P < .01). With increasing age, the difference in relative inclination between CDOAs and patients increased (P = .01). CONCLUSIONS Findings indicate that attitudes towards length and quality of life differ by life stage. This has implications for end-of-life care decisions made by CDOAs, such as purchasing health or disability insurance and signing advance directives or care plans.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ling Xiang
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | | | - Noreen Chan
- National University Cancer Institute, Singapore
| | - Eric Andrew Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Abstract
OBJECTIVE Communication based on patient preferences can alleviate their psychological distress and is an important part of patient-centered care for physicians who have the task of conveying bad news to cancer patients. The present study aimed to explore the demographic, medical, and psychological factors associated with patient preferences with regard to communication of bad news. METHODS Outpatients with a variety of cancers were consecutively invited to participate in our study after their follow-up medical visit. A questionnaire assessed their preferences regarding the communication of bad news, covering four factors-(1) how bad news is delivered, (2) reassurance and emotional support, (3) additional information, and (4) setting-as well as on demographic, medical, and psychosocial factors. RESULTS A total of 529 outpatients with a variety of cancers completed the questionnaire. Multiple regression analyses indicated that patients who were younger, female, had greater faith in their physician, and were more highly educated placed more importance on "how bad news is delivered" than patients who were older, male, had less faith in their physician, and a lower level of education. Female patients and patients without an occupation placed more importance on "reassurance and emotional support." Younger, female, and more highly educated patients placed more importance on "additional information." Younger, female, and more highly educated patients, along with patients who weren't undergoing active treatment placed more importance on "setting." SIGNIFICANCE OF RESULTS Patient preferences with regard to communication of bad news are associated with factors related to patient background. Physicians should consider these characteristics when delivering bad news and use an appropriate communication style tailored to each patient.
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44
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Costello J. Research roundup. Int J Palliat Nurs 2016. [DOI: 10.12968/ijpn.2016.22.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- John Costello
- Senior Lecturer, University of Manchester School of Nursing, Midwifery and Social Work
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45
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Wise TN. A Prescient View of Palliative Care by the Psychiatric Physician. Psychiatry 2016; 79:233-235. [PMID: 27880628 DOI: 10.1080/00332747.2016.1222213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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46
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Grassi L. Communicating anticancer treatment cessation and transition to palliative care: The need for a comprehensive and culturally relevant, person-centered approach. Cancer 2015; 121:4104-7. [PMID: 26308576 DOI: 10.1002/cncr.29638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Authorities, Ferrara, Italy
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