Approaches for end-of-life care in the field of gynecologic oncology: an exploratory study.
We sought to explore the Society of Gynecologic Oncologists (SGO) members' opinions and decisions about end-of-life issues and incurable conditions. A survey was mailed to members of the SGO. Their responses were recorded on a Likert scale and entered into a database. The survey explored opinions, experiences, and decisions in managing terminally ill gynecologic oncology patients. Of 900 surveys, 327 were returned (response rate, 36%). Seventy-three percent were men, 89% were white, and 72% were of Christian denomination. Respondents believed that 97% of patients who are dying realize that they are dying but stated only 40% of these patients initiate conversations about end-of-life issues. In contrast, 92% of respondents stated that they initiate end-of-life discussions with patients. Ninety-two percent of respondents thought that the patients should be allowed to make end-of-life choices independently after the facts are given to them. However, 44% thought that it is important to influence the way information is presented, and 54% believe that the gynecologic oncologist (GO) controls the outcome of end-of-life discussions. Although the physicians' sex, race, religion, and age did not correlate with their treatment decisions, religion did correlate with less fear of death (P = 0.011) and less discomfort when talking with patients about death (P = 0.005). Fifty-four percent of respondents believed that the GO controls the outcome of end-of-life discussions, and 40% believe that their actions prolong the process of dying. Expanding our understanding of what motivates GOs to recommend continued treatment over palliation is important for preserving informed patient-motivated end-of-life decisions.
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. lramonde@mdanderson.org
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Ramondetta
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Tortolero-Luna
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Bodurka
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Sills
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Basen-Engquist
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Gano
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Levenback
D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D005260:Female; D005833:Genital Neoplasms, Female / Q000523:psychology / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D014342:Truth Disclosure