A National Survey to Systematically Identify Factors Associated With Oncologists’ Attitudes Toward End-of-Life Discussions: What Determines Timing of End-of-Life Discussions?

Abstract

Background. End-of-life discussions (EOLds) occur infrequently until cancer patients become terminally ill. Methods. To identify factors associated with the timing of EOLds, we conducted a nationwide survey of 864 medical oncologists. We surveyed the timing of EOLds held with advanced cancer patients regarding prognosis, hospice, site of death, and do-not-resuscitate (DNR) status; and we surveyed physicians' experience of EOLds, perceptions of a good death, and beliefs regarding these issues. Multivariate analyses identified determinants of early discussions. Results. Among 490 physicians (response rate: 57%), 165 (34%), 65 (14%), 47 (9.8%), and 20 (4.2%) would discuss prognosis, hospice, site of death, and DNR status, respectively, "now" (i.e., at diagnosis) with a hypothetical patient with newly diagnosed metastatic cancer. In multivariate analyses, determinants of discussing prognosis "now" included the physician perceiving greater importance of autonomy in experiencing a good death (odds ratio [OR]: 1.34; p 5 .014),

Limiting treatment and shortening of life: data from a cross-sectional survey in Germany on frequencies, determinants and patients’ involvement

“…The responses of the physicians indicate that in about half of the cases, decisions about limiting and the consequence of possible or intended hastening death had been discussed with the patient at least some time prior to the actual limiting of treatment. Evidence indicates that the time of discussing end-of-life issues depends on perceived competences and further characteristics from the side of the physician [39, 40]. In the group in which there had not been a discussion with patients, this has been explained by the respondents with reference to the physicians’ judgment that the patient was deemed not able to make a competent decision.…”

Ensuring Quality in Online Palliative Care Resources

“…This requires that cancer professionals are familiar with the role of palliative care and comfortable in discussing palliative care considerations with their patients. However, attitudes to, and use of, palliative care services and approaches vary among oncology professionals and cancer services [28,29,30,31]. This is turn may affect the care received by patients and their quality of life in the end stage of the disease.…”

Explicit prognostic disclosure to Asian women with breast cancer: A randomized, scripted video‐vignette study (J‐SUPPORT1601)

“…34 We used the difference between STAI-State scores before and after each video. 3,15,36 The success of the manipulation-how explicit the prognostic information was perceived as being-was measured using a 10-point scale (from "not at all" to "very" explicit). 1,35 The response was rated on an NRS (range, 0-10), with a higher score indicating a higher level of satisfaction, and the mean scores of the 5 items were calculated.…”

“…[7][8][9] Like Western countries, the importance of selfdetermination has increasingly been recognized in several Asian countries; currently, most Asian patients are told of the diagnosis of cancer, and ACP is promoted at a national level. [12][13][14][15] For example, previous surveys in East Asia showed that most physicians would not discuss end-of-life issues, including a poor prognosis, with patients who have advanced cancer. [12][13][14][15] For example, previous surveys in East Asia showed that most physicians would not discuss end-of-life issues, including a poor prognosis, with patients who have advanced cancer.…”