Preferences on the Timing of Initiating Advance Care Planning and Withdrawing Life-Sustaining Treatment between Terminally-Ill Cancer Patients and Their Main Family Caregivers: A Prospective Study

Cheng-Pei Lin, Jen-Kuei Peng, Ping-Jen Chen, Hsien-Liang Huang, Su-Hsuan Hsu and Shao-Yi Cheng
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Cheng-Pei Lin: Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London SE5 9PJ, UK
Jen-Kuei Peng: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei 100229, Taiwan
Ping-Jen Chen: Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
Hsien-Liang Huang: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei 100229, Taiwan
Su-Hsuan Hsu: Department of Family Medicine, Taipei City Hospital, Taipei 10341, Taiwan
Shao-Yi Cheng: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei 100229, Taiwan

IJERPH, 2020, vol. 17, issue 21, 1-13

Abstract: Background : The Western individualistic understanding of autonomy for advance care planning is considered not to reflect the Asian family-centered approach in medical decision-making. The study aim is to compare preferences on timing for advance care planning initiatives and life-sustaining treatment withdrawal between terminally-ill cancer patients and their family caregivers in Taiwan. Methods : A prospective study using questionnaire survey was conducted with both terminally-ill cancer patient and their family caregiver dyads independently in inpatient and outpatient palliative care settings in a tertiary hospital in Northern Taiwan. Self-reported questionnaire using clinical scenario of incurable lung cancer was employed. Descriptive analysis was used for data analysis. Results : Fifty-four patients and family dyads were recruited from 1 August 2019 to 15 January 2020. Nearly 80% of patients and caregivers agreed that advance care planning should be conducted when the patient was at a non-frail stage of disease. Patients’ frail stage of disease was considered the indicator for life-sustaining treatments withdrawal except for nutrition and fluid supplements, antibiotics or blood transfusions. Patient dyads considered that advance care planning discussions were meaningful without arousing emotional distress. Conclusion : Patient dyads’ preferences on the timing of initiating advance care planning and life-sustaining treatments withdrawal were found to be consistent. Taiwanese people’s medical decision-making is heavily influenced by cultural characteristics including relational autonomy and filial piety. The findings could inform the clinical practice and policy in the wider Asia–Pacific region.

Keywords: advance care planning; life-sustaining treatment; medical decision-making; relational autonomy; terminal cancer (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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