Article of the Month
Preferences of patients with advanced lung cancer regarding the involvement of family and others in medical decision-making
Pardon K et al. on behalf of the EOLIC-Consortium
Journal of Palliative Medicine 2010; 13 (10) : 1199-1203
The involvement of family members or close friends in the decision-making process of the patients with cancer should be considered by physicians in order to respect patients’ autonomy. However, in daily clinical practice it is not always possible to have written advanced directives of patients regarding this specific issue, particularly when they are no longer competent.
The aim of this prospective study was to investigate the preferences of competent patients with advanced lung cancer concerning their wishes regarding the involvement of family and/or others, and their preferences in case they are no longer able to make medical decisions.
The research questions were:
1. who do patients with advanced lung cancer want to involve in medical decision-making while they are competent and are these persons involved?
2. who do patients with advanced lung cancer want to involve in medical decision-making when they are no longer able to make decisions themselves, and to what degree?
The patients were asked to select one or more of four possible answers regarding the person(s) to be involved in medical decision-making: a nurse, family/close friends, no one, or other people.
Quality of life was measured with the Dutch version of the EORTC QLQ-C15-PAL.
128 consecutive patients (mean age 64.4; 78% male) with NSCLC stage IIIb or IV were recruited by oncologists and pulmonologists over a one year period during the course of their disease in 13 hospitals in Flanders, Belgium.
Trained interviewers used a structured questionnaire every two months until the 4 th interview and every four months until the 6 th interview. All 128 patients were interviewed at least once and 13 patients were interviewed six consecutive times.
At baseline, the patients’ life expectancy was 10.6 ± 4.5 months, 76% of the patients had a partner, 76% lived at home with others, 73% were religious; 82% were on chemotherapy and 23% were on RT; 87.5% had an ECOG PS of 0-1
At the first interview 68.7% of patients wanted family to be involved in medical decision-making, 0.0% wanted nurses and 1.6% other; and 29.7% wanted no one involved. This percentage did not changed significantly over about 15 months. 17.6% of the patients changed their preference for family involvement between the 1 st and 2 nd interview.
A total of 93.6% of patients wanted family involvement in decision-making if they lost competence, 23% of these preferring a primary physician; 41% wanted both physician and family control and 36% desired primarily family control. About 50% of the patients changed their preference over time.
Why I have choose this article
During the course of a patient’s oncological illness, the involvement of their family, nurses, primary physician or others in medical decision-making is a topical issue if they become incompetent.
This study shows that these patients can change their minds over time regarding their future preferences about the degree of family involvement in decision making.
For this reason, physicians should regularly discuss preferences with their patients.
Dr. Carla Ripamonti is an IAHPC Board Member, she lives in Italy and her biography may be viewed at http://www.hospicecare.com/Bio/c_ripamonti.htm |
