Decision-making in patients with advanced cancer compared with amyotrophic lateral sclerosis
Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year s...
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Format: | Electronic Article |
Language: | English |
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BMJ Publ.
2008
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In: |
Journal of medical ethics
Year: 2008, Volume: 34, Issue: 9, Pages: 664-668 |
Online Access: |
Presumably Free Access Volltext (JSTOR) Volltext (lizenzpflichtig) Volltext (lizenzpflichtig) |
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245 | 1 | 0 | |a Decision-making in patients with advanced cancer compared with amyotrophic lateral sclerosis |
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520 | |a Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis (ALS) were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning ventilator support, artificial nutrition and hydration (ANH), resuscitation (DNR) and hospice care. A Kaplan-Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support (31% vs 0%, p<0.001), ANH (38% vs 0%, p<0.001), DNR (25% vs 0%, p<0.001) and hospice care (22% vs 5%, p = 0.03). At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients (p<0.001).Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. | ||
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700 | 1 | |a Sood, J. R. |e VerfasserIn |4 aut | |
700 | 1 | |a Nolan, M. T. |e VerfasserIn |4 aut | |
700 | 1 | |a Terry, P. B. |e VerfasserIn |4 aut | |
700 | 1 | |a Clawson, L. |e VerfasserIn |4 aut | |
700 | 1 | |a Kub, J. |e VerfasserIn |4 aut | |
700 | 1 | |a Hughes, M. |e VerfasserIn |4 aut | |
700 | 1 | |a Sulmasy, D. P. |e VerfasserIn |4 aut | |
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