RT Journal Article
SR Electronic
T1 Decision-making in patients with advanced cancer compared with amyotrophic lateral sclerosis
JF Journal of Medical Ethics
JO J Med Ethics
FD BMJ Publishing Group Ltd and Institute of Medical Ethics
SP 664
OP 668
DO 10.1136/jme.2007.022731
VO 34
IS 9
A1 Astrow, A B
A1 Sood, J R
A1 Nolan, M T
A1 Terry, P B
A1 Clawson, L
A1 Kub, J
A1 Hughes, M
A1 Sulmasy, D P
YR 2008
UL http://jme.bmj.com/content/34/9/664.abstract
AB Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis (ALS) were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning ventilator support, artificial nutrition and hydration (ANH), resuscitation (DNR) and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support (31% vs 0%, p&lt;0.001), ANH (38% vs 0%, p&lt;0.001), DNR (25% vs 0%, p&lt;0.001) and hospice care (22% vs 5%, p = 0.03). At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients (p&lt;0.001).Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making.