Considerations of healthcare professionals in medical decision-making about treatment for clinical end-stage cancer patients.
In order to determine which considerations healthcare professionals use in decision-making about treatment for inpatients with end-stage cancer, we observed 110 discussions at multidisciplinary meetings at two oncology departments. The discussions concerned 74 patients. Thirty-three of the 110 discussions concerned potentially life-prolonging or life-shortening treatments. The most important decision-making considerations were chance of improvement, patient's treatment wishes, amount of suffering, and the chance of therapy being successful. Discussions resulted in 6 decisions that might shorten life, 10 decisions that might prolong life, and 23 postponements of decisions because of lack of information. These observations confirm that medical interventions with a possible life-prolonging or life-shortening effect are a frequently discussed issue in medical decision-making for end-stage cancer patients in The Netherlands. Before making a decision, healthcare professionals gather extensive information about what gain is to be expected from an intervention. When healthcare professionals establish that a decision would be medically appropriate, the patient's wish will often be an important consideration.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
Anna F
AF
van Leeuwen
Elsbeth
E
Voogt
Adriaan
A
Visser
Carin C D
CC
van der Rijt
Agnes
A
van der Heide
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003625:Data Collection; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D005065:Euthanasia / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data*; D028761:Withholding Treatment / Q000706:statistics & numerical data