Abstract
Purpose: We evaluated decision-making regarding their end-of-life (EOL) care planning near death of cancer patients. Methods: We characterized EOL decision-making using the medical records of 52 patients of death from cancer, and preference of physicians or surgeons based on semi-structured interviews. Results: For 49 (94%) out of 52 patients, physicians discussed EOL care planning near death with family, whereas family made decision regarding EOL care planning near death in 48 (92%) of patients in the last hours or days of life. Four patients (8%) made their own decisions regarding EOL care planning near death. The median number of days between discussion regarding EOL care planning near death and actual patient death was 4 days. The most common reason for the inability of the patients to make the decision themselves was because their condition had deteriorated. With regard to EOL care policy, all 52 patients requested that resuscitation not be attempted, this was the same for patients who made EOL-decision themselves and those who did not. Eight out of 15 physicians (53%) answered that they discussed EOL care planning near death with family, whereas any physician did not answered that they discuss EOL care planning near death with patients. Conclusion: For the vast majority of patients, their family made decisions regarding EOL care planning near death because physicians preferred to discuss this planning with them instead of with the patients. Such discussions generally occurred when the patient’s death was imminent. All patients and their family preferred that resuscitation not be attempted.
