Let us talk about death: gender effects in cancer patients’ preferences for end-of-life discussions

Abstract

Purpose Patients with advanced cancer often receive suboptimal end-of-life (EOL) care. Particularly males with advanced cancer are more likely to receive EOL care that is more aggressive, even if death is imminent. Critical factors determining EOL care are EOL conversations or advance care planning. However, information about gender-related factors influencing EOL conversations is lacking. Therefore, the current study investigates gender differences concerning the content, the desired time point, and the mode of initiation of EOL conversations in cancer patients. Methods In a cross-sectional study, 186 female and male cancer patients were asked about their preferences for EOL discussions using a semi-structured interview, focusing on (a) the importance of six different topics (medical and nursing care, organizational, emotional, social, and spiritual/religious aspects), (b) the desired time point, and (c) the mode of discussion initiation. Results The importance of EOL topics differs significantly regarding issue (p = 0.002, η 2 = 0.02) and gender (p < 0.001, η 2 = 0.11). Males wish to avoid the engagement in discussions about death and dying particularly if they are anxious about their endof-life period. They wish to be addressed regarding the "hard facts" nursing and medical care only. In contrast, females prefer to speak more about "soft facts" and to be addressed about each EOL topic. Independent of gender, the majority of patients prefer to talk rather late: when the disease is getting worse (58%), at the end of their therapy, or when loosing self-sufficiency (27.5%). Conclusion The tendency of patients to talk late about EOL issues increases the risk of delayed or missed EOL conversations, which may be due to a knowledge gap regarding the possibility of disease-associated incapability. Furthermore, there are significant gender differences influencing the access to EOL conversations. Therefore, for daily clinical routine, we suggest an early two-step, gender-sensitive approach to end-of-life conversations.

‘Who would even want to talk about death?’ A qualitative study on nursing students' experiences of talking about death with terminally ill patients with cancer

“…The aforementioned questions and participant responses about talking about death with terminally ill patients with cancer underscore the communication skills that should be taught as a part of nursing education using hands-on activities. Past studies have found that training students to focus on the emotions that are elicited by death and death-related stimuli and clinical experience alleviate the traumatic impact of death and their fear of death (Seifart et al, 2020;Strang et al, 2014).…”

“…Hence, nurses may sometimes fail to support patients during the terminal period, and this can lead to a sense of ambiguity and the adoption of inappropriate approaches, such as ignoring their death anxiety and existential suffering (Strang et al, 2014). Consequently, terminally ill patients with cancer often receive suboptimal end-of-life care (Seifart et al, 2020). Past studies have found that terminally ill patients need existential support and the opportunity to talk about death (Breitbart et al, 2018;Gurdogan et al, 2019).…”

Marginalized Males, Disparate COVID-19 Outcomes, and Health Equity: A Profile of Highest Risk

“…Other regions of the country with large minority populations are witnessing the same phenomenon within Laino and Native American population ( CDC 2020b ). Preliminary evidence involving studies on gender, further, suggests males are more vulnerable to becoming critically ill/vulnerable with certain diseases/outcomes (i.e., heart disease, suicide, among others) than their female counterparts ( Seifart et al, 2020 ; Wenham et al, 2020 ), most notably, COVID-19. How prescient Blumenshine et al (2008) , among others, were over a decade ago.…”

Barrieren für Gespräche über Tod und Sterben in der Medizin

“…In einer kanadischen Studie hatten von 278 Patienten 76 % bereits über Behandlungswünsche nachgedacht, 89 % davon sprachen darüber mit einer anderen Person, in 92 % der Fälle mit einem Familienmitglied [5]. In einer deutschen Untersuchung hatten 47 % der befragten Krebsbetroffenen in fortgeschrittenen Krankheitsstadien noch nicht oder fast nicht über das Lebensende gesprochen [17].…”