ObjectivesTo synthesise empirical findings on the role of family in end-of-life (EOL) communication and to identify the communicative practices that are essential for EOL decision-making in family-oriented cultures.SettingThe EOL communication settings.ParticipantsThis integrative review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Relevant studies published between 1 January 1991 and 31 December 2021 were retrieved from four databases, including the PsycINFO, Embase, MEDLINE and Ovid nursing databases, using keywords with meanings of ‘end-of-life’, ‘communication’ and ‘family’. Data were then extracted and coded into themes for analysis. The search strategy yielded 53 eligible studies; all 53 included studies underwent quality assessment. Quantitative studies were evaluated using the Quality Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist was used for qualitative research.Primary and secondary outcome measuresResearch evidence on EOL communication with a focus on family.ResultsFour themes emerged from these studies: (1) conflicts in family decision-making in EOL communication, (2) the significance of timing of EOL communication, (3) difficulty in identification of a ‘key person’ who is responsible for decisions regarding EOL care and (4) different cultural perspectives on EOL communication.ConclusionsThe current review pointed towards the importance of family in EOL communication and illustrated that family participation likely leads to improved quality of life and death in patients. Future research should develop a family-oriented communication framework which is designed for the Chinese and Eastern contexts that targets on managing family expectations during prognosis disclosure and facilitating patients’ fulfilment of familial roles while making EOL decision-making. Clinicians should also be aware of the significance of the role of family in EOL care and manage family members’ expectations according to cultural contexts.
Objectives: To review the treatment outcomes of patients with chemorefractory metastatic colorectal cancer receiving the multikinase inhibitor regorafenib. Methods: This was a retrospective cohort study including patients who received regorafenib after failure of standard irinotecan-and oxaliplatin-based chemotherapy with or without biologics from 2016 to 2018 in a single centre in Hong Kong. Results: Fourteen patients met the inclusion criteria. All had good general condition (i.e., Eastern Cooperative Oncology Group score 1). Seven patients had received bevacizumab previously. Median progression-free survival (PFS) was 12.4 weeks and median overall survival (OS) was 26.5 weeks. Eight patients had grade ≥3 adverse events and 10 (71.4%) required temporary treatment suspension. The commonest grade ≥3 adverse events were palmarplantar erythrodysaesthesia and fatigue (both 28.6%). Patients with a carcinoembryonic antigen drop of ≥50% from baseline enjoyed longer PFS, though not to a significant extent. OS was longer for left-sided primary tumours (202 vs. 57 days, p = 0.001). Two patients with good performance after progression received trifluridine-tipiracil. Their median OS was 400 days. Conclusion: Our experience with regorafenib monotherapy for patients with chemorefractory metastatic colorectal cancer was comparable to the landmark trials. The grade ≥3 adverse events were frequent, and dose reduction or treatment delay was required. Potentially favourable prognostic factors included a left-sided primary tumour and a carcinoembryonic antigen drop from baseline. Those who received further treatment after regorafenib enjoyed reasonably long survival. Treatment after regorafenib with newer strategies should be considered in those who remain functional.
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