Perception of a “good death” in Thai patients with cancer and their relatives

Abstract

Background Understanding the perceptions regarding what constitutes a "good death" among cancer patients and their families could help healthcare teams to ensure proper palliative and supportive care. Objectives To demonstrate and compare the wishes cancer patients and the perceptions of their relatives regarding end-of-life care, and to identify factors associated with patients' preferences regarding place of death. Methods A sample of cancer patients and their relatives who attended the Srinagarind Hospital (Thailand) oncology clinic or day chemotherapy from September 2017 to August 2018 were enrolled. Questionnaires were given to the participants, in which the patients were asked to respond based on their own end-of-life preferences, and relatives were asked to imagine how the patients would respond to the questions. Results One hundred eighty pairs of patients and relatives were recruited. Respondents in both groups placed importance on place of death, relationship with family, physical and psychological comfort, and relationship with the medical staff. Both groups generally agreed with the statements on the questionnaire (10/13 statements). Relatives underestimated the preferences of the patients in 3 areas: “not being a burden to others,” “preparation for death,” and “physical and psychological comfort.” Being married (adjusted odds ratio (AOD) 6.4, 95%confidence interval (CI) 1.1,36.5), having had more than 6 years of education (AOD 6.5, 95%CI 1.8,23.7), having lung cancer compared to colon cancer (AOD 12, 95%CI 1.2,118.7), duration after cancer diagnosis (AOD 0.9, 95%CI 0.93,0.99), previous hospital admission (AOD 5.7, 95%CI 1.5,21.2), and life satisfaction (AOD 17.6, 95%CI 2.9,104.9) were factors associated with preference for home death. Conclusion Thai cancer patients and their relatives indicated similar preferences with regard to what constitutes a good death and patients' wishes for their end-of-life period. However, the patients' relatives underestimated the importance patients placed on statements in three domains. Factors that influenced a preference for a home death were identified.

End-of-life Care Preferences among Cancer Patients in Southern Thailand: A University Hospital-based Cross-Sectional Survey

“…This nding is consistent with those of a prior study on Northern Thai patients with a terminal illness; they desired that both physicians and relatives be involved in deciding the EoL care they received [13]. Furthermore, this nding supports the report of a former study that Asian patients were more likely to have their family involved in medical decision-making rather than exercising full autonomy or decide only by themselves like most American and European patients do [1,15,16]. Concerning this matter and in light of this nding, Thai physicians should ask their patients whether they wish to receive information regarding their health conditions and treatment and to what extent, as well as whether they would like to be involved in making decisions related to their care or prefer that their families handle such matters [17].…”

“…2) Inquiry regarding experiences with EoL care involving their relatives, which consisted of questions on experiences related to seeing someone die and being an EoL caregiver. Each item was rated as 'yes' or 'no'; the attitude toward experiences with the death of a relative was rated as 'satis ed', 'unsatis ed', or 'neither satis ed nor unsatis ed', meanwhile the attitude toward remembered death was rated as 'agree', 'disagree', or 'neither agree nor disagree' [1].…”

“…In respect to the sample size calculation, the literature review suggested that the proportion of patients that agreed with each item of EoL care preference had to be at least 50.0%. 1 The following formula was used by the researcher to calculate the sample size:…”

“…In 2018, a study found that around 9.6 million people die from cancer every year, and the number of people dying from cancer is on the rise. Cancer patients suffer from both the disease and the related therapeutic processes, especially during the terminal stage [1]. Therefore, for patients who have a life-threatening disease and a life expectancy of 6 to 12 months, the care process should focus on improving the quality of life during the end-of-life (EoL) stage in order to assist patients to die in peace and comfort, and with dignity [2].…”

Role of neuroticism and extraversion in the emotional health of people with cancer

“…Other studies have found similar results, especially regarding the negative impact of introversion on health ( Perry et al., 2018 ). Having significant relationships with friends, partners, and even healthcare professionals seems to be important to achieve an optimal emotional and psychological adaptation to the disease ( Chindaprasirt et al., 2019 ; Rokach, 2019 ; Saita et al., 2015 ).…”