Decision-Making Process for the Place of Death of Elderly Patients with Advanced Cancer and Their Families

Yoko Minamiguchi,Kumi Suzuki

doi:10.4236/ojn.2019.912093

Abstract

Purpose: This study aims to understand how elderly patients with advanced cancer and their families make a decision for a place of death for the patient. Methods: Semi-structured interviews were conducted with 17 pairs of elderly patients and members of their family. The patients had finished anticancer treatment and made some decision about the preferred place of death. A modified grounded-theory approach was used for the data analysis. Results: Making a “tentative” decision for the place of death of the elderly patients is a process with the core category [carefully choosing the final place for self-fulfillment]. The patients were “conducting a comprehensive review of the place of death” and “embracing the wishes for a way of life without difficulty”. Involving the family in making a “tentative” decision about the place of death of the elderly patients is the process with the core category [realizing the wish of patients in the terminal condition for the way for death]. The families were “examining the place of death from different aspects” and “respecting the patient’s intention as far as possible”. Conclusions: When the patients [carefully choosing the final place for self-fulfillment], it was important to reconcile their wishes with the burden on the families. When the families were trying to [realize the wish of patients in the terminal condition for the way for dying], it was important to balance the respect for the patient intentions and homecare they can provide for the patient. For the patients and their families, it is essential to mutually understand the intentions and wishes of the other party in decision making about the place of death.

Highlights

With the increasing number of elderly patients with cancer dying in Japan [1], the older the patient the more advanced the cancer staging becomes [2], and there are many elderly who are diagnosed with advanced cancer
Dying at a preferred place is very important for cancer patients to maintain their own preferred way of life till the end because it affects the quality of life (QOL) of patients and alleviates the depression and sorrow for the bereaved family [4] [5]
To make it possible for patients to die at a preferred place, it is necessary to make decisions about the place of death in advance because it has been reported that the disease conditions of cancer patients in the terminal stage tend to worsen suddenly [6], and that 42.5% of elderly patients required decisions about treatment in the final days of life and 70% of such patients lacked the capacity to make such a decision [7]

Summary

Introduction

With the increasing number of elderly patients with cancer dying in Japan [1], the older the patient the more advanced the cancer staging becomes [2], and there are many elderly who are diagnosed with advanced cancer. Even if cancer patients have decided on a preferred place of death in advance, there will be cases where the place has to be changed due to painful symptoms, decreased physical functioning, and family caregiving ability [9] This suggests that if the first decision is satisfactory for both the patients and their families, they will be able to more change the place where death is assumed to take place when the situation makes the patients wish to change the preferred place. It is indispensable to make a “tentative” decision about the place of death when anticancer treatment has ceased to be effective so that patients can maintain their QOL and die in their preferred way

Objectives

Methods

Results

Conclusion