What are cancer patients' preferences about treatment at the end of life, and who should start talking about it? A comparison with healthy people and medical staff.
OBJECTIVE
In order to strengthen cancer patients' autonomy and to improve quality of palliative care, it is necessary to know what are the patients' preferences for treatment at the end of life, whether they accept the idea of advance directives, and who should initiate the process of fulfilling such a document.


METHODS
We compared cancer patients' preferences with respect to particular treatment options at the end of life, acceptance of the idea of advance directives, and preferences for whom should initiate writing such a document with that of healthy controls, nursing staff, and physicians (n=100 each group) using a structured questionnaire.


RESULTS
Cancer patients wanted treatment with antibiotics and infringing treatments such as chemotherapy and dialysis significantly more often than healthy controls, nursing staff, and physicians (p<0.01 and p<0.001, respectively). Determinants associated with the wish to opt for these treatments were reduced health condition and older age. The groups did not differ with respect to their acceptance of advance directives; 58-75% of all those surveyed wanted their physicians to initiate a discussion about writing such a document if they thought it appropriate.


CONCLUSIONS
Cancer patients' preferences for treatment at the end of life significantly differ compared to other groups. Oncologists should initiate a discussion about an advance directive when/if the course of the illness seems to make this appropriate, which corresponds to the wish of the majority of cancer patients, healthy controls, and medical staff.
Sahm
S
S
Department of Gastroenterology/Oncology, German Clinic of Diagnosis (DKD), Aukammallee 33, 65 191, Wiesbaden, Germany. stephan.sahm@t-online.de
Will
R
R
Hommel
G
G
D000328:Adult; D016223:Advance Directives; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000928:Antidepressive Agents / Q000008:administration & dosage; D016022:Case-Control Studies; D003625:Data Collection; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008503:Medical Staff / Q000523:psychology*; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D017060:Patient Satisfaction; D006435:Renal Dialysis; D012121:Respiration, Artificial; D013727:Terminal Care
D000900:Anti-Bacterial Agents; D000928:Antidepressive Agents