Advanced Cancer and End-of-Life Preferences: Curative Intent Surgery Versus Noncurative Intent Treatment.
BACKGROUND
People with cancer face complex medical decisions, including whether to receive life-sustaining treatments at the end of life. It is not unusual for clinicians to make assumptions about patients' wishes based on whether they had previously chosen to pursue curative treatment.


OBJECTIVE
We hypothesized that cancer patients who initially underwent curative intent surgery (CIS) would prefer more aggressive end-of-life treatments compared to patients whose treatment was noncurative intent (non-CIT).


METHODS
This study was a retrospective review of data from a large, randomized controlled trial examining the use of an online decision aid for advance care planning, "Making Your Wishes Known" (MYWK), with patients who had advanced cancer. We reviewed patients' medical records to determine which patients underwent CIS versus non-CIT. In the parent trial, conducted at an academic medical center (2007-2012), 200 patients were enrolled with stage IV malignancy or other poor prognosis cancer. Patients' preferences for aggressive treatment were measured in two ways: using patient-selected General Wishes statements generated by the decision aid and patient-selected wishes for specific treatments under various hypothetical clinical scenarios (Specific Wishes).


RESULTS
We evaluated 79 patients. Of these, 48 had undergone initial CIS and 31 had non-CIT. Cancer patients who initially underwent CIS did not prefer more aggressive end-of-life treatments compared to patients whose treatment was non-CIT.


CONCLUSIONS
Clinicians should avoid assumptions about patients' preferences for life-sustaining treatment based on their prior choices for aggressive treatment.
1 Departments of Surgery and Public Health Sciences, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania.
Jane R
JR
Schubart
2 Department of Humanities, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania.
Michael J
MJ
Green
3 Department of Medicine, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania.
Lauren J
LJ
Van Scoy
4 Department of Public Health Sciences, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania.
Erik
E
Lehman
4 Department of Public Health Sciences, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania.
Elana
E
Farace
5 Department of Surgery, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania.
Niraj J
NJ
Gusani
6 Department of Pediatrics and Humanities, The Pennsylvania State University , College of Medicine, Hershey, Pennsylvania.
Benjamin H
BH
Levi
D032722:Advance Care Planning; D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D020407:Internet; D008020:Life Support Care / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013727:Terminal Care / Q000523:psychology*