1
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Buiting HM, Sonke GS. Gray oncologic areas. J Surg Oncol 2024; 129:1013-1014. [PMID: 38321584 DOI: 10.1002/jso.27598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Hilde M Buiting
- Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
- O2PZ, Platform of Palliative Care, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
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2
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Buiting HM, Sonke GS. Natural. J Surg Oncol 2024. [PMID: 38534026 DOI: 10.1002/jso.27628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Hilde M Buiting
- Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- University of Amsterdam, Amsterdam, the Netherlands
- O2PZ, Platform of Palliative Care, Amsterdam, the Netherlands
| | - Gabe S Sonke
- Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- University of Amsterdam, Amsterdam, the Netherlands
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3
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Buiting HM, van der Linden Y, Steenbruggen TG, Bolt EE, van Houdt W, Sonke GS. Oligometastases: Incorporate the patient perspective to ensure optimal treatment and care. J Surg Oncol 2024; 129:679-680. [PMID: 38100164 DOI: 10.1002/jso.27561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Hilde M Buiting
- Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
- O2PZ, Platform of Palliative Care, Amsterdam, The Netherlands
| | - Yvette van der Linden
- LUMC, Department of Radiation Oncology/Center of Expertise in Palliative Care, Leiden, The Netherlands
| | - Tessa G Steenbruggen
- Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eva E Bolt
- Amsterdam UMC/VUmc, Public and Occupational Health/CCA, Amsterdam, The Netherlands
| | - Winan van Houdt
- Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
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4
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Botman F, Brown PR, van Meggelen M, Sonke GS, Buiting HM. Balancing proximity and distance in oncology during COVID-19 times and beyond. Eur J Oncol Nurs 2023; 66:102379. [PMID: 37517340 DOI: 10.1016/j.ejon.2023.102379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Femke Botman
- University of Amsterdam, Department of Anthropology, Amsterdam, the Netherlands; Amsterdam UMC, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Patrick R Brown
- University of Amsterdam, Department of Sociology, Amsterdam, the Netherlands
| | | | - Gabe S Sonke
- Antoni van Leeuwenhoek, Department of Medical Oncology, Amsterdam, the Netherlands; University of Amsterdam, Amsterdam, the Netherlands
| | - Hilde M Buiting
- Antoni van Leeuwenhoek, Department of Medical Oncology, Amsterdam, the Netherlands; University of Amsterdam, Amsterdam, the Netherlands; O2PZ, Platform of Palliative care, Amsterdam, the Netherlands.
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Buiting HM, Botman F, van der Velden LA, Brom L, van Heest F, Bolt EE, de Mol P, Bakker T. Clinicians' experiences with cancer patients living longer with incurable cancer: a focus group study in the Netherlands. Prim Health Care Res Dev 2023; 24:e29. [PMID: 37114726 PMCID: PMC10156464 DOI: 10.1017/s1463423622000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
AIM To explore (1) experiences of primary care physicians (PCPs) and oncological medical specialists about providing care to patients living longer with incurable cancer, and (2) their preferences concerning different care approaches (palliative support, psychological/survivorship care support). BACKGROUND At present, oncological medical specialists as well as PCPs are exploring how to improve and better tailor care to patients living longer with incurable cancer. Our previous study at the in-patient oncology unit showed that patients living longer with incurable cancer experience problems in how to deal with a prognosis that is insecure and fluctuating. To date, it could be argued that treating these patients can be done with a 'palliative care' or a 'survivorship/psychosocial care' approach. It is unknown what happens in actual medical practice. METHODS We performed multidisciplinary group meetings: 6 focus groups (3 homogenous groups with PCPs (n = 15) and 3 multidisciplinary groups (n = 17 PCPs and n = 6 medical specialists) across different parts of the Netherlands. Qualitative data were analysed with thematic analysis. FINDINGS AND CONCLUSIONS In the near future, PCPs will have an increasing number of patients living longer with incurable cancer. However, in a single PCP practice, the experience with incurable cancer patients remains low, partly because patients often prefer to stay in contact with their medical specialist. PCPs as well as medical specialists show concerns in how they can address this disease phase with the right care approach, including the appropriate label (e.g. palliative, chronic, etc.). They all preferred to be in contact early in the disease process, to be able to discuss and take care for the patients' physical and psychological well-being. Medical specialists can have an important role by timely referring their patients to their PCPs. Moreover, the disease label 'chronic' can possibly assist patients to live their life in the best possible way.
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Affiliation(s)
- Hilde M Buiting
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Medical Oncology, Head & Neck Surgery, and Thoracic Oncology, Amsterdam, the Netherlands
- University of Amsterdam, Amsterdam, the Netherlands
- O2PZ, Platform of Palliative Care, Amsterdam, the Netherlands
| | - Femke Botman
- Amsterdam UMC, VUmc, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Lilly-Ann van der Velden
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Head and Neck Oncology, Amsterdam, the Netherlands
| | - Linda Brom
- Netherlands Comprehensive Cancer Organisation, Department of Research, Utrecht, the Netherlands
| | | | - Eva E Bolt
- Amsterdam UMC, VUmc, Department of Public and Occupational Health, Amsterdam, the Netherlands
| | - Pieter de Mol
- Hospital Gelderse Vallei, Department of Medical Oncology, Ede, the Netherlands
| | - Ton Bakker
- Science in Balance Foundation, Rotterdam, the Netherlands
- Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
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van Eijk M, de Vries DH, Sonke GS, Buiting HM. Friendship during patients' stable and unstable phases of incurable cancer: a qualitative interview study. BMJ Open 2022; 12:e058801. [PMID: 36400727 PMCID: PMC9677003 DOI: 10.1136/bmjopen-2021-058801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/17/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Little is known about the added value of friendship during the care of intensive cancer disease trajectories. Friends, however, can play an important (caring-)role to increase their friends' (mental) well-being. We explored the experiences and desires of friends while their ill friends were-most of the time-in a stable phase of incurable cancer. DESIGN Qualitative study in the Netherlands based on 14 in-depth interviews with friends of patients living with incurable cancer. Interviews were performed at the home setting or the friend's office. Data gathering was inspired by grounded theory and analysed with a thematic analysis. SETTING The home setting/friend's office. RESULTS Friends reported to experience difficulties in how and how often they wanted to approach their ill friends. They emphasised the ever-present knowledge of cancer inside their friends' body as a 'time bomb'. They seemed to balance between the wish to take care for their ill friend, having a good time and not knowing what their ill friend desired at specific times. Some friends felt burdened with or forced to provide more care than they could, although they acknowledged that this relationship provided space to reflect about their own life. CONCLUSIONS Friends are constantly negotiating and renegotiating their relationship depending on the severity of the disease, transparency of patients about their illness, their previous experiences and personal circumstances in life. Although a decrease in friendship may impact a patient's quality of life, friends also need to be protected against providing more care than they are willing or able to give. Healthcare professionals, being aware of this phenomenon, can assist in this.
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Affiliation(s)
- Michelle van Eijk
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Cancer Institute / Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Daniel H de Vries
- Faculty of Social and Behavioural Science, Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
| | - Hilde M Buiting
- University of Amsterdam, Amsterdam, The Netherlands
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands
- University Medical Center Utrecht, Utrecht, The Netherlands
- O2PZ Platform of Palliative care, Amsterdam, The Netherlands
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Schildmann J, Nadolny S, Buiting HM. What Do We Mean By "Palliative" or "Oncologic Care"? Conceptual Clarity Is Needed for Sound Research and Good Care. J Clin Oncol 2020; 38:2814-2815. [PMID: 32530763 DOI: 10.1200/jco.20.00658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jan Schildmann
- Jan Schildmann, MD, PhD, Faculty of Medicine, Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; Stephan Nadolny, MSc, Faculty of Medicine, Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; and Franziskus-Hospital Harderberg, Niels-Stensen-Kliniken, Georgsmarienhütte, Germany; and Hilde M. Buiting, PhD, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stephan Nadolny
- Jan Schildmann, MD, PhD, Faculty of Medicine, Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; Stephan Nadolny, MSc, Faculty of Medicine, Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; and Franziskus-Hospital Harderberg, Niels-Stensen-Kliniken, Georgsmarienhütte, Germany; and Hilde M. Buiting, PhD, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hilde M Buiting
- Jan Schildmann, MD, PhD, Faculty of Medicine, Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; Stephan Nadolny, MSc, Faculty of Medicine, Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; and Franziskus-Hospital Harderberg, Niels-Stensen-Kliniken, Georgsmarienhütte, Germany; and Hilde M. Buiting, PhD, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Affiliation(s)
| | - Gert Olthuis
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
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Buiting HM, Bolt EE. Patients with incurable cancer as a separate group of survivors in the primary care setting. Cancer 2019; 125:4541. [DOI: 10.1002/cncr.32473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Eva E. Bolt
- Department of Social Medicine Center for Palliative Care Amsterdam UMC, Location VUMC Amsterdam The Netherlands
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Buiting HM, Botman F, van der Velden LA, Brom L, van Heest F, de Mol P, Bakker T. Experiences of general practitioners and medical specialists with incurable cancer patients with a protracted disease trajectory: A focus group study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e23010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23010 Background: Advances in oncology have resulted in prolonged disease trajectories in patients with incurable cancer. In this disease-phase, patients are aware that cancer is incurable but they do not approach the last phase-of-life yet. We examined experiences and wishes of GPs and specialists concerning appropriate care-provision, delivered by GPs. Methods: We performed 6 focus groups in different regions in the Netherlands; 3 homogenous groups (N=15 GPs) and 3 heterogenous groups (N=23 GPs and medical specialists). Data were analysed with thematic content-analysis. Results: During the first focus-groups, the protracted disease phase was not acknowledged as a separate one; in the last focus-groups, however, this disease-phase received more attention. Physicians clearly distinghuished this trajectory from the palliative / terminal disease phase, partly because many patients did not experience severe physical problems. Most GPs preferred to be involved in the care of these patients as this would enable them to easily guide patients in their last phase-of-life. In these patients, GPs experienced difficulties in estimation of prognosis and advice of further treatment, partly because of insecurity of treatment side-effects of immunotherapy. Further, many physicians experienced difficulties in labeling this disease phase. ‘Stable’; ‘chronic’; and ‘Phase X’ were regularly mentioned. Medical specialists were more frequent involved with these patients but preferred to involve GPs as much as possible. They however also realised that this would become more difficult in future, given the growing group of patients in this disease phase. Conclusions: In the protracted disease phase, patients often do not experience severe physical symptoms. They often do not approach their patient for possible psycho-social problems. Apart from medical specialists, tools to easily communicate across specialties to optimise care need to be further explored.
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Affiliation(s)
- Hilde M. Buiting
- Netherlands Cancer Institute (Netherlands), Amsterdam, Netherlands
| | - Femke Botman
- University of Amsterdam, Medical Anthropology, Amsterdam, Netherlands
| | | | - Linda Brom
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | | | - Pieter de Mol
- Radboud University Medical Center, Nijmegen, Netherlands
| | - Ton Bakker
- Stichting Wetenschap Balans, Rotterdam, Netherlands
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Buiting HM, van Ark MAC, Dethmers O, Maats EPE, Stoker JA, Sonke GS. Complex challenges for patients with protracted incurable cancer: an ethnographic study in a comprehensive cancer centre in the Netherlands. BMJ Open 2019; 9:e024450. [PMID: 30928932 PMCID: PMC6475444 DOI: 10.1136/bmjopen-2018-024450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Advances in oncology increasingly result in protracted disease trajectories for patients with incurable cancer. In this disease phase, patients are aware of the incurable nature of cancer although they are not yet approaching the last phase of life. We explored the challenges for patients confronted with protracted incurable cancer. DESIGN Ethnographic study (2015-2017) based on conversations with patients, observations at a day-care unit and a selection of information from the medical records of patients who died during the study period. SETTING The day-care unit of a comprehensive cancer centre in the Netherlands. PARTICIPANTS Nineteen patients with stage IV breast cancer (in remission, >1 year after diagnosis) and 11 patients with stage IV lung-cancer (in remission, >6 months after diagnosis). RESULTS In patients who had died during the study period, the treatment response often fluctuated between stable, remission and progression throughout the course of the disease. Patients reported that this fluctuation could be overwhelming. However, as patients grew accustomed to having protracted incurable cancer, the distress associated with fluctuations (perceived in scan results) slowly faded. Patients reported that cancer became part of who they were. At the day-care unit, most patients talked about their disease in an optimistic or neutral way and expressed delight in life. They often expressed gratefulness for the possible prolongation of life, expressed hope and tried to stay optimistic. This was frequently reinforced by optimistic doctors and nurses. Relatives, however, could downplay such optimism. Moreover, some patients acknowledged that hope was qualified by their personal challenges regarding their disease. CONCLUSIONS In situations where tumours remained in remission or were stable for extended periods, patients grew accustomed to having cancer. At the day-care unit, medical professionals typically encouraged an attitude of being hopeful and optimistic, which could be downplayed by relatives. More research is warranted to explore this protracted disease phase and this optimistic view among healthcare professionals.
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Affiliation(s)
- Hilde M Buiting
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marleen A C van Ark
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Clinical Psychology, Department of Behavioural and Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Otto Dethmers
- Oncology day-care unit, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Emma P E Maats
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jogien A Stoker
- Medical Psychology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Centre of Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gabe S Sonke
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Buiting HM, Botman F, Busink V, Oomen E, Ho VK. "Everything that is not curative is now palliative": A nurse perspective. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.34_suppl.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
127 Background: Advances in oncology increasingly result in protracted disease trajectories for patients with incurable cancer. This phase can be described as advanced / metastatic cancer and in which anti-cancer treatment should control symptoms, slow disease progression, and/or prolong life. It poses new challenges for patients and their doctors; it is unknown how and which disease labels are used by nurses. Methods: Qualitative ethnographic study, based on in-depth interviews with 13 oncology nurses at the day-care unit in a Dutch comprehensive cancer hospital. Results: A substantial number of nurses reported not to know whether patients were treated with a curative or palliative intent, and to follow a patient-centred approach. Other nurses clearly demarcated palliative patients, and some distinguished "real palliative patients" from patients with long-standing incurable cancer. When nurses were explicitly asked about medical terminology, many nurses were not very positive about the term "palliative". They considered this to be an old term, e.g. "Now everything that is not curative is palliative". Moreover, the term "palliative" could have an ambiguous/threatening meaning, especially for patients. Whereas nurses often associated the term "palliative" with alleviating symptoms, for patients this term was frequently associated with the approaching death. Most nurses therefore preferred not to use the term "palliative" in front of the patient; but only amongst nurses themselves. Since nurses had not previously been provoked to think about other terms, they were unsure whether "chronic" was the right term. Some indicated that cancer was rather different compared to other chronic diseases, others felt unsure when to use the term "chronic" at all. Conclusions: According to nurses, the use of specific medical terms such as "chronic" to describe the situation of patients in protracted disease trajectories is unclear. Although they acknowledge differences across the palliative care continuum, they refrain from using the word "palliative" in front of the patient. Nurses’ awareness of the disease stage (curative/palliative/ "chronic") might be important to optimise to patients’ specific needs in every disease phase.
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Affiliation(s)
| | - Femke Botman
- University of Amsterdam, Medical Anthropology, Amsterdam, Netherlands
| | - Veerle Busink
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Elzbeth Oomen
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Vincent K.Y. Ho
- Comprehensive Cancer Center The Netherlands, Utrecht, Netherlands
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Buiting HM, de Bree R, Brom L, Mack JW, van den Brekel M. Adding shared laughter to optimise shared medicine. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.34_suppl.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
43 Background: Most people are familiar with the expression "laughter is the best medicine". By triggering endorphin release and strengthening relationships, it can be considered a perfect holistic care-approach. We explored the occurrence, acceptability, and functions of humor and laughter in patients with incurable cancer. Methods: We performed 16 in-depth interviews with patients with incurable cancer at the day-care unit of a Dutch comprehensive cancer hospital. We further performed and online questionnaire-study among 33 oncologists (41% of 81 approached) about experiences with humour and laughter in breast, lung, head and neck, or urological cancer. Results: Nearly all oncologists reported using humour (97%), and all reported to sometimes laugh during consultations; 83% reported experiencing a positive effect of laughter. These results were in line with patients’ experiences: Patients noted that humor always stayed alive, despite having incurable cancer. Apart from this human aspect, patients also used humor to broach difficult topics and to downplay challenges. Some patients explicated that the appreciation of humor was dependent on the type of humor, since humor is rather personal. Patients and oncologists acknowledged that using humor is delicate, and sometimes inappropriate, partly because they did not always share the same type of humor. Laughter, in contrast, was regarded as ‘lighter’ than humor, and could, accordingly, more easily be implemented. However, both patients and specialists cautioned against patients using laughter to avoid uncertainty or broach difficult topics. Conclusions: Our results suggest that patients and healthcare professionals can benefit from humour or laughter. Many conversations were joyful, even in the midst of medical challenges. Although humor is personal, laughter can be applied more easily. Healthcare professionals therefore need to have a basic comprehension of the impact of laughter to facilitate discussions, improve the doctor-patient relationship, and identify underlying wishes. If applied appropriately, shared laughter will possibly add to optimise shared medicine.
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Affiliation(s)
| | - Remco de Bree
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Linda Brom
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Jennifer W. Mack
- Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Boston, MA
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Affiliation(s)
- Hilde M. Buiting
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Tjomme de Graas
- Department of Anesthesiology (Supportive Care), Netherlands Cancer Institute, Amsterdam, the Netherlands
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Affiliation(s)
- Jacqueline Stouthard
- Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Linda Brom
- Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Hilde M Buiting
- Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam, the Netherlands
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16
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Buiting HM, Brink M, Wijnhoven MN, Lokker ME, van der Geest LG, Terpstra WE, Sonke GS. Doctors' reports about palliative systemic treatment: A medical record study. Palliat Med 2017; 31:239-246. [PMID: 27492158 DOI: 10.1177/0269216316661685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Decisions about palliative systemic treatment are key elements of palliative and end-of-life care. Such decisions must often be made in complex, clinical situations. AIM To explore the content of medical records of patients with advanced non-small cell lung cancer and pancreatic cancer with specific emphasis on doctors' notes about decisions on palliative systemic treatment. DESIGN Medical record review (2009-2012) of 147 cancer patients containing 276 notes about palliative systemic treatment. We described the proportion of notes/medical records containing pre-specified items relevant to palliative systemic treatment. We selected patients using the nationwide Netherlands Cancer Registry. SETTING Hospital based. RESULTS About 75% of all notes reported doctors' considerations to start/continue palliative systemic treatment, including information about the prognosis (47%), possible survival gain (22%), patients' wish for palliative systemic treatment (33%), impact on quality of life (8%), and patient's age (3%). Comorbidity (82%), smoking status (78%) and drinking behaviour (63%) were more often documented than patients' performance status (16%). Conversations with the patient/family about palliative systemic treatment were reported in 49% of all notes. Response measurements and dose adaptations were documented in 75% and 71% of patients who received palliative systemic treatment respectively. CONCLUSION Medical records provide insight into the decision-making process about palliative systemic treatment. The content and detail of doctors' notes, however, widely varies especially concerning their palliative systemic treatment considerations. Registries that aim to measure the quality of (end-of-life) care must be aware of this outcome. Future research should further explore how medical records can best assist in evaluating the quality of the decision-making process in the patient's final stage of life.
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Affiliation(s)
- Hilde M Buiting
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,2 Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mirian Brink
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Marleen N Wijnhoven
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,3 Department of Clinical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Martine E Lokker
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Lydia Gm van der Geest
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Wim E Terpstra
- 4 Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Gabe S Sonke
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,5 Department of Medical Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Buiting HM, van den Heuvel MM. Evaluating Chemotherapy at the End of Life. JAMA Oncol 2016; 2:143-4. [DOI: 10.1001/jamaoncol.2015.4108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hilde M. Buiting
- Antoni van Leeuwenhoek Hospital–Netherlands Cancer Institute, Amsterdam, the Netherlands
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Buiting HM, Linn SC, Smorenburg CH, de Kanter W. [Living with incurable cancer]. Ned Tijdschr Geneeskd 2016; 160:A9615. [PMID: 27122068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Anti-cancer treatments for various subtypes of cancer have significantly improved. As a result, the number of cancer patients who cannot be completely cured but may live for a considerable period of time is growing. A 72-year-old woman was diagnosed with metastatic EGFR-mutated non-small-cell lung cancer. She received anti-tumour treatment with gefitinib for almost two years and experienced only limited side effects. She was anxious about not knowing her prognosis but after visiting a psychologist she feels as if she can continue life. A 46-year-old woman started to experience symptoms of depression two years after treatment for metastatic breast cancer. A visit to a psycho-oncologist proved to be very helpful. She does not want to know her prognosis and is particularly happy that everything is going well at present. These two cases illustrate that patients living longer with incurable cancer may experience specific dilemmas. We make several recommendations for the care of this group of patients.
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Wijnhoven MN, Terpstra WE, van Rossem R, Haazer C, Gunnink-Boonstra N, Sonke GS, Buiting HM. Bereaved relatives' experiences during the incurable phase of cancer: a qualitative interview study. BMJ Open 2015; 5:e009009. [PMID: 26608635 PMCID: PMC4663398 DOI: 10.1136/bmjopen-2015-009009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine bereaved relatives' experiences from time of diagnosis of incurable cancer until death with specific emphasis on their role in the (end-of-life) decision-making concerning chemotherapy. DESIGN Qualitative interview study. SETTING Hospital-based. PARTICIPANTS AND METHODS In-depth interviews with 15 close relatives of patients who died from non-small cell lung cancer or pancreatic cancer, using a thematic content analysis. RESULTS All relatives reported that patients' main reason to request chemotherapy was the possibility to prolong life. Relatives reported that patients receiving chemotherapy had more difficulty to accept the incurable nature of their disease than patients who did not. They mostly followed the patients' treatment wish and only infrequently suggested ceasing chemotherapy (because of side effects) despite sometimes believing that this would be a better option. Relatives continuously tried to support the patient in either approaching the death or in attaining hope to continue life satisfactorily. Most relatives considered the chemotherapy period meaningful, since it sparked patients' hope and was what patients wanted. Cessation of chemotherapy caused a relief but coincided with physical deterioration and an increased caregivers' role; many relatives recalled this latter period as more burdensome. CONCLUSIONS Relatives tend to follow patients' wish to continue or cease chemotherapy, without expressing their own feelings, although they were more inclined to opt cessation. They experience a greater caregiver role after cessation and their feelings of responsibility associated with the disease can be exhausting. More attention is needed to reduce relatives' distress at the end of life, also to fully profit from this crucial form of (informal) healthcare.
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Affiliation(s)
- Marleen N Wijnhoven
- Department of Registry & Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Wim E Terpstra
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ronald van Rossem
- Department of Pulmonology, Reinier de Graafgroep, Delft, The Netherlands
| | - Carolien Haazer
- Department of Internal Medicine, Reinier de Graafgroep, Delft, The Netherlands
| | | | - Gabe S Sonke
- Department of Registry & Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hilde M Buiting
- Department of Registry & Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
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Affiliation(s)
- Hilde M Buiting
- Comprehensive Cancer Centre the Netherlands (IKNL), Rochussentraat 125, 3015 EJ Rotterdam, Netherlands
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Perrels AJ, Fleming J, Zhao J, Barclay S, Farquhar M, Buiting HM, Brayne C. Place of death and end-of-life transitions experienced by very old people with differing cognitive status: retrospective analysis of a prospective population-based cohort aged 85 and over. Palliat Med 2014; 28:220-33. [PMID: 24317193 DOI: 10.1177/0269216313510341] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite fast-growing 'older old' populations, 'place of care' trajectories for very old people approaching death with or without dementia are poorly described and understood. AIM To explore end-of-life transitions of 'older old' people across the cognitive spectrum. DESIGN Population-based prospective cohort (United Kingdom) followed to death. SETTING/PARTICIPANTS Mortality records linked to 283 Cambridge City over-75s Cohort participants' cognitive assessments <1 year before dying aged ≥ 85 years. RESULTS Overall, 69% were community dwelling in the year before death; of those with severe cognitive impairment 39% were community dwelling. Only 6% subsequently changed their usual address. However, for 55% their usual address on death registration was not their place of death. Dying away from the 'usual address' was associated with cognition, overall fewer moving with increasing cognitive impairment - cognition intact 66%, mildly/moderately impaired 55% and severely impaired 42%, trend p = 0.003. This finding reflects transitions being far more common from the community than from institutions: 73% from the community and 28% from institutions did not die where last interviewed (p < 0.001). However, severely cognitively impaired people living in the community were the most likely group of all to move: 80% (68%-93%). Hospitals were the most common place of death except for the most cognitively impaired, who mostly died in care homes. CONCLUSION Most very old community-dwelling individuals, especially the severely cognitively impaired, died away from home. Findings also suggest that long-term care may play a role in avoidance of end-of-life hospital admissions. These results provide important information for planning end-of-life services for older people across the cognitive spectrum, with implications for policies aimed at supporting home deaths. MESH TERMS: Cognitive impairment, Dementia, Aged, 80 and over, Aged, frail elderly, Patient Transfer, Residential characteristics, Homes for the aged, Nursing Homes, Delivery of Health Care, Terminal care Other key phrases: Older old, Oldest old, Place of death, Place of care, End-of-life care.
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Affiliation(s)
- Anouk J Perrels
- 1Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
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Buiting HM, Terpstra W, Dalhuisen F, Gunnink-Boonstra N, Sonke GS, den Hartogh G. The facilitating role of chemotherapy in the palliative phase of cancer: qualitative interviews with advanced cancer patients. PLoS One 2013; 8:e77959. [PMID: 24223130 PMCID: PMC3819324 DOI: 10.1371/journal.pone.0077959] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/06/2013] [Indexed: 01/13/2023] Open
Abstract
Objective To explore the extent to which patients have a directing role in decisions about chemotherapy in the palliative phase of cancer and (want to) anticipate on the last stage of life. Design Qualitative interview study. Methods In depth-interviews with 15 patients with advanced colorectal or breast cancer at the medical oncology department in a Dutch teaching hospital; interviews were analysed following the principles of thematic content-analysis. Results All patients reported to know that the chemotherapy they received was with palliative intent. Most of them did not express the wish for information about (other) treatment options and put great trust in their physicians’ treatment advice. The more patients were aware of the severity of their disease, the more they seemed to ‘live their life’ in the present and enjoy things besides having cancer. Such living in the present seemed to be facilitated by the use of chemotherapy. Patients often considered the ‘chemotherapy-free period’ more stressful than periods when receiving chemotherapy despite their generally improved physical condition. Chemotherapy (regardless of side-effects) seemed to shift patients’ attention away from the approaching last stage of life. Interestingly, although patients often discussed advance care planning, they were reluctant to bring on end-of-life issues that bothered them at that specific moment. Expressing real interest in people ‘as a person’ was considered an important element of appropriate care. Conclusions Fearing their approaching death, patients deliberately focus on living in the present. Active (chemotherapy) treatment facilitates this focus, regardless of the perceived side-effects. However, if anxiety for what lies ahead is the underlying reason for treatment, efforts should be made in assisting patients to find other ways to cope with this fear. Simultaneously, such an approach may reduce the use of burdensome and sometimes costly treatment in the last stage of life.
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Affiliation(s)
- Hilde M. Buiting
- Comprehensive Cancer Center The Netherlands, Department of Registry and Research, Utrecht, The Netherlands
- University of Amsterdam, Department of Philosophy, Amsterdam, The Netherlands
- * E-mail:
| | - Wim Terpstra
- Onze Lieve Vrouwe Gasthuis, Department of Internal Medicine, Amsterdam, The Netherlands
| | - Floriske Dalhuisen
- Comprehensive Cancer Center The Netherlands, Department of Registry and Research, Utrecht, The Netherlands
| | | | - Gabe S. Sonke
- Comprehensive Cancer Center The Netherlands, Department of Registry and Research, Utrecht, The Netherlands
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam, The Netherlands
| | - Govert den Hartogh
- University of Amsterdam, Department of Philosophy, Amsterdam, The Netherlands
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Buiting HM, Deeg DJH, Knol DL, Ziegelmann JP, Pasman HRW, Widdershoven GAM, Onwuteaka-Philipsen BD. Older peoples' attitudes towards euthanasia and an end-of-life pill in The Netherlands: 2001-2009. J Med Ethics 2012; 38:267-273. [PMID: 22240587 DOI: 10.1136/medethics-2011-100066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION With an ageing population, end-of-life care is increasing in importance. The present work investigated characteristics and time trends of older peoples' attitudes towards euthanasia and an end-of-life pill. METHODS Three samples aged 64 years or older from the Longitudinal Ageing Study Amsterdam (N=1284 (2001), N=1303 (2005) and N=1245 (2008)) were studied. Respondents were asked whether they could imagine requesting their physician to end their life (euthanasia), or imagine asking for a pill to end their life if they became tired of living in the absence of a severe disease (end-of-life pill). Using logistic multivariable techniques, changes of attitudes over time and their association with demographic and health characteristics were assessed. RESULTS The proportion of respondents with a positive attitude somewhat increased over time, but significantly only among the 64-74 age group. For euthanasia, these percentages were 58% (2001), 64% (2005) and 70% (2008) (OR of most recent versus earliest period (95% CI): 1.30 (1.17 to 1.44)). For an end-of-life pill, these percentages were 31% (2001), 33% (2005) and 45% (2008) (OR (95% CI): 1.37 (1.23 to 1.52)). For the end-of-life pill, interaction between the most recent time period and age group was significant. CONCLUSIONS An increasing proportion of older people reported that they could imagine desiring euthanasia or an end-of-life pill. This may imply an increased interest in deciding about your own life and stresses the importance to take older peoples' wishes seriously.
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Affiliation(s)
- Hilde M Buiting
- Department of Social Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Hesselink BAM, Onwuteaka-Philipsen BD, Janssen AJGM, Buiting HM, Kollau M, Rietjens JAC, Pasman HRW. Do guidelines on euthanasia and physician-assisted suicide in Dutch hospitals and nursing homes reflect the law? A content analysis. J Med Ethics 2012; 38:35-42. [PMID: 21708831 DOI: 10.1136/jme.2010.041020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process.
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Affiliation(s)
- B A M Hesselink
- VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, Amsterdam, The Netherlands.
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Buiting HM, Willems DL, Pasman HRW, Rurup ML, Onwuteaka-Philipsen BD. Palliative treatment alternatives and euthanasia consultations: a qualitative interview study. J Pain Symptom Manage 2011; 42:32-43. [PMID: 21477981 DOI: 10.1016/j.jpainsymman.2010.10.260] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 09/29/2010] [Accepted: 10/06/2010] [Indexed: 01/03/2023]
Abstract
CONTEXT There is much debate about euthanasia within the context of palliative care. The six criteria of careful practice for lawful euthanasia in The Netherlands aim to safeguard the euthanasia practice against abuse and a disregard of palliative treatment alternatives. Those criteria need to be evaluated by the treating physician as well as an independent euthanasia consultant. OBJECTIVES To investigate 1) whether and how palliative treatment alternatives come up during or preceding euthanasia consultations and 2) how the availability of possible palliative treatment alternatives are assessed by the independent consultant. METHODS We interviewed 14 euthanasia consultants and 12 physicians who had requested a euthanasia consultation. We transcribed and analyzed the interviews and held consensus meetings about the interpretation. RESULTS Treating physicians generally discuss the whole range of treatment options with the patient before the euthanasia consultation. Consultants actively start thinking about and proposing palliative treatment alternatives after consultations, when they have concluded that the criteria for careful practice have not been met. During the consultation, they take into account various aspects while assessing the criterion concerning the availability of reasonable alternatives, and they clearly distinguish between euthanasia and continuous deep sedation. Most consultants said that it was necessary to verify which forms of palliative care had previously been discussed. Advice concerning palliative care seemed to be related to the timing of the consultation ("early" or "late"). Euthanasia consultants were sometimes unsure whether or not to advise about palliative care, considering it not their task or inappropriate in view of the previous discussions. CONCLUSION Two different roles of a euthanasia consultant were identified: a limited one, restricted to the evaluation of the criteria for careful practice, and a broad one, extended to actively providing advice about palliative care. Further medical and ethical debate is needed to determine consultants' most appropriate role.
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Affiliation(s)
- Hilde M Buiting
- VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam, The Netherlands.
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Abstract
OBJECTIVE To examine health professionals' experiences of and attitudes towards the provision of chemotherapy to patients with end stage cancer. DESIGN Purposive, qualitative design based on in-depth interviews. Setting Oncology departments at university hospitals and general hospitals in the Netherlands. PARTICIPANTS 14 physicians and 13 nurses who cared for patients with metastatic cancer. RESULTS Physicians and nurses reported trying to inform patients fully about their poor prognosis and treatment options. They would carefully consider the (side) effects of chemotherapy and sometimes doubted whether further treatment would contribute to patients' quality of life. Both groups considered the patients' wellbeing to be important, and physicians seemed inclined to try to preserve this by offering further chemotherapy, often followed by the patient. Nurses were more often inclined to express their doubts about further treatment, preferring to allow patients to make the best use of the time that is left. When confronted with a treatment dilemma and a patient's wish for treatment, physicians preferred to make compromises, such as by "trying out one dose." Discussing death or dying with patients while at the same time administering chemotherapy was considered contradictory as this could diminish the patients' hope. CONCLUSIONS The trend to greater use of chemotherapy at the end of life could be explained by patients' and physicians' mutually reinforcing attitudes of "not giving up" and by physicians' broad interpretation of patients' quality of life, in which taking away patients' hope by withholding treatment is considered harmful. To rebalance the ratio of quantity of life to quality of life, input from other health professionals, notably nurses, may be necessary.
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Affiliation(s)
- Hilde M Buiting
- Department of Philosophy, University of Amsterdam, Oude Turfmarkt 141-147, 1012 GC Amsterdam, the Netherlands.
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Buiting HM, Clayton JM, Butow PN, van Delden JJ, van der Heide A. Artificial nutrition and hydration for patients with advanced dementia: perspectives from medical practitioners in the Netherlands and Australia. Palliat Med 2011; 25:83-91. [PMID: 20870688 DOI: 10.1177/0269216310382589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The appropriate use of artificial nutrition or hydration (ANH) for patients with advanced dementia continues to be a subject of debate. We investigated opinions of Dutch and Australian doctors about the use of ANH in patients with advanced dementia. We interviewed 15 Dutch doctors and 16 Australian doctors who care for patients with advanced dementia. We transcribed and analysed the interviews and held consensus meetings about the interpretation. We found that Dutch and Australian doctors use similar medical considerations when they decide about the use of ANH. In general, they are reluctant to start ANH. Disparities between the Dutch and Australian doctors are related to the process of decision-making: Dutch doctors seem to put more emphasis on a comprehensive assessment of the patient's actual situation, whereas Australian doctors are more inclined to use scientific evidence and advance directives. Furthermore, Dutch doctors take the primary responsibility themselves whereas Australian general practitioners seem to be more inclined to leave the decision to the family. It seems that Dutch and Australian doctors use somewhat different care approaches for patients with advanced dementia. Combining the Dutch comprehensive approach and the Australian analytic approach may serve the interest of patients and their families best.
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Affiliation(s)
- Hilde M Buiting
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.
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Buiting HM, van der Heide A, Onwuteaka-Philipsen BD. No increase in demand for euthanasia following implementation of the Euthanasia Act in The Netherlands; pain as a reason for euthanasia request was increasing before implementation but declined subsequently. Evid Based Med 2010; 15:159-160. [PMID: 20667905 DOI: 10.1136/ebm1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Hilde M Buiting
- VU University Medical Center, Department of Social Medicine, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands.
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Buiting HM, Karelse MAC, Brouwers HAA, Onwuteaka-Philipsen BD, van der Heide A, van Delden JJM. Dutch experience of monitoring active ending of life for newborns. J Med Ethics 2010; 36:234-237. [PMID: 20338936 DOI: 10.1136/jme.2009.034397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15-20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. METHODS Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. RESULTS In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. DISCUSSION The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed.
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Affiliation(s)
- Hilde M Buiting
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, Rotterdam 3000 CA, The Netherlands.
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Buiting HM, van der Heide A, Onwuteaka-Philipsen BD, Rurup ML, Rietjens JAC, Borsboom G, van der Maas PJ, van Delden JJM. Physicians' labelling of end-of-life practices: a hypothetical case study. J Med Ethics 2010; 36:24-29. [PMID: 20026689 DOI: 10.1136/jme.2009.030155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To investigate why physicians label end-of-life acts as either 'euthanasia/ending of life' or 'alleviation of symptoms/palliative or terminal sedation', and to study the association of such labelling with intended reporting of these acts. METHODS Questionnaires were sent to a random, stratified sample of 2100 Dutch physicians (response: 55%). They were asked to label six hypothetical end-of-life cases: three 'standard' cases and three cases randomly selected (out of 47), that varied according to (1) type of medication, (2) physician's intention, (3) type of patient request, (4) patient's life expectancy and (5) time until death. We identified the extent to which characteristics of cases are associated with physician's labelling, with multilevel multivariable logistic regression. RESULTS The characteristics that contributed most to labelling cases as 'euthanasia/ending of life' were the administration of muscle relaxants (99% of these cases were labelled as 'euthanasia/ending of life') or disproportional morphine (63% of these cases were labelled accordingly). Other important factors were an intention to hasten death (54%) and a life expectancy of several months (46%). Physicians were much more willing to report cases labelled as 'euthanasia' (87%) or 'ending of life' (56%) than other cases. CONCLUSIONS Similar cases are not uniformly labelled. However, a physicians' label is strongly associated with their willingness to report their acts. Differences in how physicians label similar acts impede complete societal control. Further education and debate could enhance the level of agreement about what is physician-assisted dying, and thus should be reported, and what not.
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Affiliation(s)
- H M Buiting
- Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Rietjens JAC, Buiting HM, Pasman HRW, van der Maas PJ, van Delden JJM, van der Heide A. Deciding about continuous deep sedation: physicians' perspectives: a focus group study. Palliat Med 2009; 23:410-7. [PMID: 19304807 DOI: 10.1177/0269216309104074] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although guidelines restrict the use of continuous deep sedation to patients with refractory physical symptoms and a short life-expectancy, its use is not always restricted to these conditions. A focus group study of physicians was conducted to gain more insight in the arguments for and against the use of continuous deep sedation in several clinical situations. Arguments in favour of continuous deep sedation for patients with a longer life-expectancy were that the overall clinical situation is more relevant than life-expectancy alone, and that patients' wishes should be followed. Continuous deep sedation for patients with predominantly emotional/existential suffering was considered appropriate when physicians empathize with the suffering. Further, some physicians indicated that they may consider the use of sedation in the context of a euthanasia request. Arguments were that the option of continuous deep sedation is a better alternative; it may comfort some patients when their thoughts about potential future suffering become unbearable. Further, some considered continuous deep sedation as less burdening or a bother to perform. We conclude that physicians' decision-making about continuous deep sedation is characterized by balancing the interests of patients with their own feelings. Accordingly, the reasons for its use are not unambiguous and need further debate.
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Affiliation(s)
- J A C Rietjens
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
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Rurup ML, Buiting HM, Pasman HRW, van der Maas PJ, van der Heide A, Onwuteaka-Philipsen BD. The Reporting Rate of Euthanasia and Physician-Assisted Suicide. Med Care 2008; 46:1198-202. [DOI: 10.1097/mlr.0b013e31817d69e8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Buiting HM, Rietjens JAC, Onwuteaka-Philipsen BD, van der Maas PJ, van Delden JJM, van der Heide A. A comparison of physicians' end-of-life decision making for non-western migrants and Dutch natives in the Netherlands. Eur J Public Health 2008; 18:681-7. [PMID: 18820307 DOI: 10.1093/eurpub/ckn084] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-western migrants have a different cultural background that influences their attitudes towards healthcare. As the first wave of this relatively young group is growing older, we investigated, for the first time, whether end-of-life decision-making practices for non-western migrants differ from Dutch natives. METHODS In 2005, we sent questionnaires to physicians who attended deaths identified from the central death registry of Statistics Netherlands (n = 9651; non-western migrants: n = 627, total response: 78%). We performed multivariate logistic regression analyses adjusted for age, sex and cause of death. RESULTS Of all deaths of non-western origin, 54% were non-sudden, whereas 67% of all deaths with a Dutch origin were non-sudden (P = 0.00). A relatively large number of non-suddenly deceased persons of non-western origin had died under the age of 65 (53%) as compared to Dutch natives (15%). Euthanasia was performed in 2.4% of all non-suddenly deceased persons in the non-western migrant group as compared to 2.7% in the native Dutch group (adjusted odds ratio = 0.82, P = 0.63). Alleviation of symptoms with a potential life-shortening effect was somewhat lower for non-western migrants (30% vs. 38%; adjusted odds ratio = 0.78, P = 0.07). Physicians decided to forgo potentially life-prolonging treatment in comparable rates (26% vs. 23%; adjusted odds ratio = 1.1, P = 0.73). Yet, the type of treatments forgone and underlying reasons differed. CONCLUSION Euthanasia was not less common among non-suddenly deceased non-western migrants as compared to Dutch natives. However, intensive symptom alleviation was used less frequently and forgoing potentially life-prolonging treatment involved different characteristics. These findings suggest that cultural factors may affect end-of-life decision making.
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Affiliation(s)
- Hilde M Buiting
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
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Buiting HM, Gevers JKM, Rietjens JAC, Onwuteaka-Philipsen BD, van der Maas PJ, van der Heide A, van Delden JJM. Dutch criteria of due care for physician-assisted dying in medical practice: a physician perspective. J Med Ethics 2008; 34:e12. [PMID: 18757612 DOI: 10.1136/jme.2008.024976] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The Dutch Euthanasia Act (2002) states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient's suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these criteria in medical practice. METHODS In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians (response rate: 56%). Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act. RESULTS Of all physicians who had received a request for euthanasia or assisted suicide (75%), 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient's suffering was unbearable and hopeless (79%) and whether or not the patient's request was voluntary or well considered (58%). DISCUSSION Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient's subjective perspective(s). However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act.
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Affiliation(s)
- H M Buiting
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Buiting HM, van Delden JJM, Rietjens JAC, Onwuteaka-Philipsen BD, Bilsen J, Fischer S, Löfmark R, Miccinesi G, Norup M, van der Heide A. Forgoing artificial nutrition or hydration in patients nearing death in six European countries. J Pain Symptom Manage 2007; 34:305-14. [PMID: 17606359 DOI: 10.1016/j.jpainsymman.2006.12.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 12/04/2006] [Accepted: 12/06/2006] [Indexed: 11/23/2022]
Abstract
Whether or not artificial nutrition or hydration (ANH) may be forgone in terminally ill patients has been the subject of medical and ethical discussions. Information about the frequency and background characteristics of making decisions to forgo ANH is generally limited to specific clinical settings. The aim of this study was to compare the practice of forgoing ANH in six European countries: Belgium, Denmark, Italy, The Netherlands, Sweden, and Switzerland. In each country, random samples were drawn from death registries. Subsequently, the reporting physician received a questionnaire about the medical decisions that preceded the patient's death. The total number of deaths studied was 20,480. The percentage of all deaths that were preceded by a decision to forgo ANH varied from 2.6% in Italy to 10.9% in The Netherlands. In most countries, decisions to forgo ANH were more frequently made for female patients, patients aged 80 years or older, and for patients who died of a malignancy or disease of the nervous system (including dementia). Of patients in whom ANH was forgone, 67%-93% were incompetent. Patients in whom ANH was forgone did not receive more potentially life-shortening drugs to relieve symptoms than other patients for whom other end-of-life decisions had been made. Decisions to forgo ANH are made in a substantial percentage of terminally ill patients. Providing all patients who are in the terminal stage of a lethal disease with ANH does not seem to be a widely accepted standard among physicians in Western Europe.
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Affiliation(s)
- Hilde M Buiting
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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van der Heide A, Onwuteaka-Philipsen BD, Rurup ML, Buiting HM, van Delden JJM, Hanssen-de Wolf JE, Janssen AGJM, Pasman HRW, Rietjens JAC, Prins CJM, Deerenberg IM, Gevers JKM, van der Maas PJ, van der Wal G. End-of-life practices in the Netherlands under the Euthanasia Act. N Engl J Med 2007; 356:1957-65. [PMID: 17494928 DOI: 10.1056/nejmsa071143] [Citation(s) in RCA: 308] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices. METHODS We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%. RESULTS In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used. CONCLUSIONS The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.
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Affiliation(s)
- Agnes van der Heide
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.
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