Paradoxes in advance care planning: the complex relationship of oncology patients, their physicians, and advance medical directives.

Title

Paradoxes in advance care planning: the complex relationship of oncology patients, their physicians, and advance medical directives.

Creator

Dow LA; Matsuyama RK; Ramakrishnan V; Kuhn L; Lamont EB; Lyckholm L; Smith TJ

Publisher

Journal Of Clinical Oncology

Date

2010

Subject

Female; Humans; Male; Young Adult; Palliative Care; Terminal Care; Family; Adult; Interviews as Topic; Aged; Middle Aged; Physicians; Medical Oncology; 80 and over; advance care planning; DNAR; Advance Directives; Physician-Patient Relations; Patient Preference; Neoplasms/px [Psychology]

Description

PURPOSE: Many seriously ill patients with cancer do not discuss prognosis or advance directives (ADs), which may lead to inappropriate and/or unwanted aggressive care at the end of life. Ten years ago, patients with cancer said they would not like to discuss ADs with their oncologist but would be willing to discuss them with an admitting physician. We assessed whether this point of view still held., PATIENTS AND METHODS: Semi-structured interviews were conducted with 75 consecutively admitted patients with cancer in the cancer inpatient service., RESULTS: Of those enrolled, 41% (31 of 75) had an AD. Nearly all (87%, 65 of 75) thought it acceptable to discuss ADs with the admitting physician with whom they had no prior relationship, and 95% (62 of 65) thought that discussing AD issues was very or somewhat important. Only 7% (5 of 75) had discussed ADs with their oncologist, and only 23% (16 of 70) would like to discuss ADs with their oncologist. When specifically asked which physician they would choose, 48% (36 of 75) of patients would prefer their oncologist, and 35% (26 of 75) would prefer their primary care physician., CONCLUSION: Fewer than half of seriously ill patients with cancer admitted to an oncology service have an AD. Only 23% (16 of 70) would like to discuss their ADs with their oncologist but nearly all supported a policy of discussing ADs with their admitting physician. However, fully 48% (36 of 75) actually preferred to discuss advance directives with their oncologist if AD discussion was necessary. We must educate patients on why communicating their ADs is beneficial and train primary care physicians, house staff, hospitalists, and oncologists to initiate these difficult discussions.
2010

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Citation

Dow LA; Matsuyama RK; Ramakrishnan V; Kuhn L; Lamont EB; Lyckholm L; Smith TJ, “Paradoxes in advance care planning: the complex relationship of oncology patients, their physicians, and advance medical directives.,” Pediatric Palliative Care Library, accessed May 19, 2024, https://pedpalascnetlibrary.omeka.net/items/show/14034.