Abstract
Purpose: In the terminal cancer stage, the discrepancies between the clinically appropriate treatment plans and the wishes of patients and family members sometimes occur. The purpose of this study was to clarify the causes and countermeasures of these problems.
Subjects and Methods: We surveyed 29 patients who were admitted to our hospital over the past one year.
Results: Causes: a) Lack of understanding about the disease was observed in 19 patients, and b) expectations for the treatment in 10 patients. Countermeasures: Appropriate modifications regarding the treatment were made after having discussions in 14 patients for a), and support was provided after showing sympathy in 6 patients for b). Since we could not obtain the patients' and family members' understanding in 5 patients for a) and in 4 patients for b), we tentatively performed the treatments based on the wishes of patients and family members and evaluated regularly the influences of these treatments to the patients (timelimited trial). Outcomes: Due to increased overflow of fluid and insufficient improvement of the nutritional conditions, the treatment regimens were changed in all patients 2 to 7 days after the initiation of this trial. Patients' burden caused by this trial was reduced by the subsequent treatments.
Conclusion: In order to provide appropriate parenteral nutritional treatment for terminally ill cancer patients, good communication between medical professionals and patients and family members, and consideration for patients' burden when performing a time-limited trial are essential.
