title: End-of-life decision-making of terminally ill cancer patients in a tertiary cancer center in Shanghai, China.
abstract: OBJECTIVE
  Different countries have various decision-making practices, which are formalized according to laws, rules, traditions, religious beliefs, and ethical views of different cultural backgrounds. We investigated the characteristics and factors associated with the decision-making details in terminally ill cancer patients in a tertiary cancer center in Shanghai, China.
  
  
  METHODS
  A single center, retrospective study was performed among advanced cancer patients who died between March 2007 and December 2013 in ward at Palliative Care Unit, Fudan University Shanghai Cancer Center.
  
  
  RESULTS
  Of 436 patients' end-of-life (EOL) discussions, 424 (97.2 %) occurred between family caregivers and physicians. The main decision-maker was in the following order: spouse (45.6 %), offsprings (44.3 %), parents (3.2 %), son-/daughter-in-law (1.8 %), and relatives (1.4 %). Two hundred twenty-one (47.3 %) patients received at least one of six life-sustaining treatments. One hundred eighty-four (40.4 %) patients continued artificial nutrition and hydration (ANH) until death. Cardiopulmonary resuscitation (CPR) was performed in 26 patients (6.0 %). Two hundred fourteen (49.1 %) patients received vasopressors before death. Only two patients received mechanical ventilation and only one patient received tracheostomy. The median time interval since the decision made till death was 20.17 h (95 % CI = 18.94-21.40, range 4.3 to 70.2 h). Patients who were older than 65 years old were less likely to undergo an intensive procedure (AOR = 0.559, 95 % CI = 0.367-0.852, p = 0.007). Patients living in urban settings (AOR = 2.177, 95 % CI = 1.398-3.390, p = 0.001) were more likely to undergo an intensive procedure in the EOL period.
  
  
  CONCLUSIONS
  This study reflected some Chinese characteristics for decision-making at the end of life among advanced cancer patients. More prospective studies focused on specific EOL issues are required to improve the quality of EOL care.
authors.affiliation: Department of Integrated Therapy, Fudan University Shanghai Cancer Center, #270, DongAn Road, Shanghai, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Gu
authors.affiliation: Department of Integrated Therapy, Fudan University Shanghai Cancer Center, #270, DongAn Road, Shanghai, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
authors.forename: Menglei
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Integrated Therapy, Fudan University Shanghai Cancer Center, #270, DongAn Road, Shanghai, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
authors.forename: Minghui
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Integrated Therapy, Fudan University Shanghai Cancer Center, #270, DongAn Road, Shanghai, People's Republic of China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Integrated Therapy, Fudan University Shanghai Cancer Center, #270, DongAn Road, Shanghai, People's Republic of China. wenwucheng@yahoo.com.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. wenwucheng@yahoo.com.
authors.forename: Wenwu
authors.initials: W
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D003657:Decision Making; D005260:Female; D017051:Hospice Care / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data; D019452:Terminally Ill / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Decision-making; End-of-life; Life-sustaining treatment; Palliative care