Preferences on the Timing of Initiating Advance Care Planning and Withdrawing Life-Sustaining Treatment between Terminally-Ill Cancer Patients and Their Main Family Caregivers: A Prospective Study
Journal
International journal of environmental research and public health
Journal Volume
17
Journal Issue
21
Date Issued
2020
Author(s)
Abstract
Background: The Western individualistic understanding of autonomy for advance care planning is considered not to reflect the Asian family-centered approach in medical decision-making. The study aim is to compare preferences on timing for advance care planning initiatives and life-sustaining treatment withdrawal between terminally-ill cancer patients and their family caregivers in Taiwan. Methods: A prospective study using questionnaire survey was conducted with both terminally-ill cancer patient and their family caregiver dyads independently in inpatient and outpatient palliative care settings in a tertiary hospital in Northern Taiwan. Self-reported questionnaire using clinical scenario of incurable lung cancer was employed. Descriptive analysis was used for data analysis. Results: Fifty-four patients and family dyads were recruited from 1 August 2019 to 15 January 2020. Nearly 80% of patients and caregivers agreed that advance care planning should be conducted when the patient was at a non-frail stage of disease. Patients' frail stage of disease was considered the indicator for life-sustaining treatments withdrawal except for nutrition and fluid supplements, antibiotics or blood transfusions. Patient dyads considered that advance care planning discussions were meaningful without arousing emotional distress. Conclusion: Patient dyads' preferences on the timing of initiating advance care planning and life-sustaining treatments withdrawal were found to be consistent. Taiwanese people's medical decision-making is heavily influenced by cultural characteristics including relational autonomy and filial piety. The findings could inform the clinical practice and policy in the wider Asia-Pacific region.
Subjects
advance care planning; life-sustaining treatment; medical decision-making; relational autonomy; terminal cancer
Advance care planning; Life-sustaining treatment; Medical decision-making; Relational autonomy; Terminal cancer
SDGs
Other Subjects
antibiotic agent; cancer; decision making; disease treatment; health care; health policy; policy approach; preference behavior; questionnaire survey; respiratory disease; adult; advance care planning; Article; blood transfusion; cancer patient; caregiver; comparative study; controlled study; cultural anthropology; emotional stress; family decision making; female; fluid intake; frailty; health survey; hospital patient; human; life sustaining treatment; lung cancer; major clinical study; male; medical decision making; middle aged; nutritional support; outpatient care; patient preference; personal autonomy; prospective study; questionnaire; self report; Taiwan; Taiwanese; terminally ill patient; tertiary care center; treatment withdrawal; aged; Asia; family health; neoplasm; terminal care; Pacific Ocean; Pacific Rim; Taiwan; Indicator indicator; Advance Care Planning; Aged; Asia; Caregivers; Family Health; Female; Humans; Male; Middle Aged; Neoplasms; Prospective Studies; Taiwan; Terminal Care
Publisher
MDPI
Type
journal article