Abstract

BackgroundCancer patients’ end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals.MethodsCancer patients who were at the end-of-life and attended in participating hospitals were identified. When these patients deceased, their attending physician was invited to participate. Attending physicians of 261 cancer patients (out of 348 identified) accepted the invitation and answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the first two decision types, we asked if the decision was fully or partially made with the intention or consideration that it may hasten the patient’s death.ResultsDecisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids.Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was fulfilled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n = 114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n = 38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied.ConclusionsDecisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance care directives and potentially life-shortening effects of treatment decisions. Specific end-of-life procedures, patients’ wishes, and availability of palliative care should be further investigated.

Highlights

  • Cancer patients’ end-of-life care may involve complex decision-making processes

  • Decisions concerning the end of life were common for patients with cancer in three Colombian hos‐ pitals, including euthanasia and palliative sedation

  • We documented medical decisions taken during the last month of life of 261 cancer patients who died between May 2019 and May 2020 in one of three teaching hospitals: Instituto Nacional de Cancerología (INC), Hospital Universitario San Ignacio (HUSI) and Hospital San José (HUSJ)

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Summary

Introduction

Cancer patients’ end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. When cancer patients enter into the last phase of their lives, they often suffer substantially due to pain or other symptoms, or even from the absence of any perspective on improvement In such situations, decisions need to be made regarding patient comfort [1]. Decisions need to be made regarding patient comfort [1] These decisions may affect the remaining duration of the patient’s life, their subjective experience during that time or help to address their wishes at the time of death and beyond. Some patients experience their suffering in the last phase of life as unbearable and ask their doctor for euthanasia. Euthanasia is defined as follows: a physician intentionally ending a person’s life by the administration of drugs, at that competent person’s voluntary request [2]

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