Decisional conflict in end‐of‐life cancer treatment among family surrogates: A cross‐sectional survey

Abstract

The aims of this study were to examine the extent of decisional conflict in end-of-life cancer treatments and to investigate the influences and predictors of decisional conflict among family surrogates. A cross-sectional, descriptive, correlational design was applied. Data were collected from a convenience sample of 102 family members who had participated in end-of-life cancer decision-making. We enrolled participants from inpatient oncology units at a university hospital in South Korea from May 2014 to January 2016. The results indicated that many family surrogates had high levels of decisional conflict and psychological stress after end-of-life cancer decision-making. Hierarchical multiple regression analyses demonstrated that decisional conflict had significant, substantial influences on decision regret and psychological stress after controlling for demographic variables. Family surrogates who were aware of the patients' wishes about end-of-life treatments and those who had good family functioning had less decisional conflict. To relieve decisional conflict regarding end-of-life cancer treatment among family surrogates, it is necessary to encourage patients to share their end-of-life treatment wishes with family members and to consider family functioning in the end-of-life decision-making process.

Associations of surrogates' death‐preparedness states with decisional conflict and heightened decisional regret over cancer patients' last 6 months of life

“…This high prevalence contrasts with the literature consensus that a minority of individuals experience heightened decisional regret when they make decisions (primarily not EOL‐care decisions) for themselves 9 or others 11,16,34 . Our participants' decisional regret may be more comparable to that of Korean surrogates who decided about forgoing life‐sustaining treatments for their relative (mean = 45.4) 10 . We also observed that surrogates' likelihood of heightened decisional regret increased as their relative's death approached (Table 3).…”

“…Our participants' decisional conflict level is substantially higher than those of US surrogates making EOL‐care decisions (mean DCS scores ranged 21.5–25.5 30,34,35 ) but is comparable with those reported among international patients and surrogates making palliative‐care decisions (mean = 45.0) 5 . However, our participants' mean was markedly lower than that for Korean surrogates who decided to forgo their relative's life‐sustaining treatments (mean = 56.3, n = 102), 10 a rare decision in our study (4.1%, Supporting Information S1: Table 1). Deciding to withdraw/withhold life‐sustaining treatments is extremely difficult for Asian families due to the strong cultural, Confucian influence of filial duty 4 to use every means to keep a relative alive.…”

“…Decisional conflict may predispose patients to subsequent decisional regret, 9 but this relationship has seldom been examined for surrogates 5 . Moreover, limited evidence shows that both before and after loss heightened decisional regret is a risk factor for surrogates' psychological distress, that is, higher psychological stress, 10 anxiety symptoms, 11 and prolonged‐grief‐disorder 12 symptoms.…”

“…6,8 Decisional conflict may predispose patients to subsequent decisional regret, 9 but this relationship has seldom been examined for surrogates. 5 Moreover, limited evidence shows that both before and after loss heightened decisional regret is a risk factor for surrogates' psychological distress, that is, higher psychological stress, 10 anxiety symptoms, 11 and prolonged-grief-disorder 12 symptoms. EOL-care decision making is fraught with cognitive and emotional challenges for surrogates, who frequently do not accurately know and overestimate the patient's prognosis 13 and treatment preferences.…”

What matters when doctors die: A qualitative study of family perspectives

“…Although the physician-patients were more informed than most lay patients about their illness, prognosis and treatment options and their family caregivers were also well educated, family caregivers reported concerns that have been reported among lay family caregivers. For example, family caregivers talked about their desire to reach consensus with other family members on treatment and care decisions for the physician patient but recognized that some level of conflict among the family members might occur [33]. Similar to other studies of caregivers of persons with serious illness, faith beliefs and religious practices provided great comfort to some of the family members of the physician-patients especially near death, but divergent beliefs created conflict [34].…”