Experiences and Opinions Related to End-of-Life Discussion: From Oncologists' and Resident Physicians' Perspectives

Abstract

PurposeThe aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care.Materials and MethodsA survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t test, and the chisquare test were performed for the analyses.ResultsA total of 147 oncologists and 229 residents participated in this study. The study respondents reported diverse definitions of “terminal state,” and mostrespondents tried to disclose the patient’s condition to the patient and/or family members. Both groups were involved in EOL care discussions, with a rather low satisfaction level (57.82/100). The best timing to initiate discussionwas consideredwhen metastasis or disease recurrence occurred orwhen withdrawal of chemotherapy was anticipated. Furthermore, the study respondents suggested that patients and their family members should be included in the EOL discussion. Medical, legal, and ethical knowledge and communication difficulties along with practical issues were revealed as barriers and facilitators for EOL discussion.ConclusionThis study explored various perspectives of oncologists and resident physicians for EOL discussion. Since the Life-Sustaining-Treatment Decision-Making Act will be implemented shortly in Korea, now is the time for oncologists and residents to prepare themselves by acquiring legal knowledge and communication skills. To achieve this, education, training, and clinical tools for healthcare professionals are required.

Physicians' Views on Advance Care Planning and End‐of‐Life Care Conversations

“…Training alone, according to physician respondents, is not sufficient. As observed in other studies, conversations were much more likely to occur when the practice or healthcare system has a formal system in place for assessing patients' end‐of‐life wishes and goals of care, yet fewer than one‐third of physicians responding had such a system in place. This suggests that policymakers should consider additional ways beyond payment to stimulate inclusion of ACP in the practice and health system infrastructure.…”

Differences in perspectives of pediatricians on advance care planning: a cross-sectional survey

“…An earlier study in the United States reported that parental factors (unrealistic expectation, insufficient understanding of prognosis, and lack of readiness) are the most prevalent barriers to ACP [8]. Further, Korean oncologists (internal medicine) also opined that familial factors (reluctance, hope, and conflict) and unclear prognosis are more frequent barriers than a lack of systemic support or scarcity of knowledge, which correspond to the results of the current study [22]. According to the result, only 20 participants (22.4%) received appropriate education in this matter (Table 1) and 55.0% were lacking in confidence regarding pediatric ACP (data not shown).…”

Attitudes of the General Public, Cancer Patients, Family Caregivers, and Physicians Toward Advance Care Planning: A Nationwide Survey Before the Enforcement of the Life-Sustaining Treatment Decision-Making Act

“…Significant changes have been anticipated in communication about end-of-life care following the act. 7 It emphasizes patients to play a central role in ACP. 8 However, having patients directly involved in ACP for end-of-life care is still unusual.…”