Requests to forgo potentially life-prolonging treatment and to hasten death in terminally ill cancer patients: a prospective study.
This study investigates the background and evolution of requests to forgo treatment and hasten death in terminally ill cancer patients. Physicians participating in a nationwide study on end-of-life decision making were asked whether they were treating a terminally ill cancer patient whose life expectancy was longer than 1 week but no longer than 3 months and who they would continue to treat until the patient's death. Of the 120 physicians who had a patient who met the inclusion criteria, 85 (70.8%) completed a questionnaire each month until the patient's death. The questionnaire provided information on the patient's symptoms, concerns, and requests involving end-of-life decisions. Most patients suffered from cancer of the gastrointestinal tract or the respiratory system, and 66% died within 2 months of the initial interview. The prevalence of requests involving end-of-life decisions increased during the last 3 months of a patient's life. The evolution of a request was especially related to an increase in the number of severe symptoms and concerns. Requests to forgo treatment were related to general weakness, whereas loss of dignity was a major reason for requests to hasten death. Physical suffering alone appeared to lead to less drastic requests than suffering blended by concerns and psychological problems leading to requests for hastened death. The results emphasize the importance of gaining insight into the patients' suffering to provide meaningful assistance.
Department of Public and Occupational Health, Erasmus University Medical Center, Rotterdam, The Netherlands. j.georges@vumc.nl
Jean-Jacques
JJ
Georges
Bregje D
BD
Onwuteaka-Philipsen
Agnes
A
van der Heide
Gerrit
G
van der Wal
Paul J
PJ
van der Maas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D005065:Euthanasia / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D012297:Right to Die; D013727:Terminal Care / Q000706:statistics & numerical data*; D028761:Withholding Treatment / Q000706:statistics & numerical data*