Disclosure Of Terminal Illness Research Articles

The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients

We aimed to assess whether awareness of a terminal illness can affect care decision making processes and the achievement of a good death in advanced cancer patients receiving palliative care services. Awareness of terminal illness at the time of palliative care service admission was assessed by the health care professionals during the routine initial comprehensive assessment process and was recorded in the national terminal cancer patient registry. A follow-up nationwide bereavement survey was conducted, which contained questions regarding decision making processes and the Korean version of the Good Death Inventory. Among the 345 patients included in the final analysis, the majority (68.4%) of the patients were aware of the terminal illness. Awareness of the terminal illness tended to reduce discordances in care decision making (adjusted odds ratio = 0.55; 95% CI: 0.29-1.07), and increased the patients' own decision making when there were discordances between patients and their families (adjusted odds ratio = 3.79; 95% CI: 1.31-10.94). The Good Death Inventory score was significantly higher among patients who were aware of their terminal illnesses compared with those who were not (5.04 vs. 4.80; p = 0.013) and especially in the domains of 'control over the future' (5.18 vs. 4.04; p < 0.001), 'maintaining hope and pleasure' (4.55 vs. 3.92; p = 0.002), and 'unawareness of death' (4.41 vs. 4.26; p = 0.024). Awareness of the terminal illness had beneficial effect on the harmonious decision making, patient autonomy, and patient's quality of death. Disclosure of terminal illness should be encouraged.

Impact of Awareness of Terminal Illness and Use of Palliative Care or Intensive Care Unit on the Survival of Terminally Ill Patients With Cancer: Prospective Cohort Study

We conducted this study to evaluate the validity of the perception that awareness of their terminal prognosis and use of palliative care or nonuse of an intensive care unit (ICU) causes patients to die sooner than they would otherwise. In this prospective cohort study at 11 university hospitals and the National Cancer Center in Korea, we administered questionnaires to 619 consecutive patients immediately after they were determined by physicians to be terminally ill. We followed patients during 6 months after enrollment and assessed how their survival was affected by the disclosure of terminal illness and administration of palliative care or nonuse of the ICU. In a follow-up of 481 patients and 163.8 person-years, we identified 466 deceased patients. Nineteen percent of the patients died within 1 month, while 41.3% lived for 3 months, and 17.7% lived for 6 months. Once the cancer was judged terminal, the median survival time was 69 days. On multivariate analysis, neither patient awareness of terminal status at baseline (adjusted hazard ratio [aHR], 1.20; 95% CI, 0.96 to 1.51), use of a palliative care facility (aHR, 0.96; 95% CI, 0.76 to 1.21), nor general prostration (aHR, 1.23; 95% CI, 0.96 to 1.57) was associated with reduced survival. Use of the ICU (aHR, 1.47; 95% CI, 1.06 to 2.05) and poor Eastern Cooperative Oncology Group performance status (aHR, 1.37; 95% CI, 1.10 to 1.71) were significantly associated with poor survival. Patients' being aware that they are dying and entering a palliative care facility or ICU does not seem to influence patients' survival.

Death education and attitudes toward euthanasia and terminal illness.

The attitudes of a random sample of Cleveland clergy toward the experience of terminal illness and the circumstances justifying euthanasia are presented and analyzed. The clergy response patterns revealed that, although eager to prolong life as long as possible, terminally ill patients fear a prolonged period of illness more than death itself. They also agreed that most patients favor the disclosure of terminal illness. The clergy's response to a questionnaire exhibited a definite ranking (i.e., scaling) in the order of priority of the different circumstances justifying passive euthanasia. Using training in death counseling as a control variable produced sharper division in the response categories for each statement. The controversial nature of euthanasia and the problem of ascertaining the psychological needs of the terminally ill became more apparent with the group who had more training in death counseling. Interpretations of the findings are presented, and a need for a careful reexamination of the effects of death education on attitudes toward controversial subjects in death and dying is stressed.

Euthanasia, the terminal patient, and the physician's role.

A random sample of Cleveland clergy was asked to assess 1) the terminal patient's views on death, 2) the desires of some terminally ill patients to find an easy and dignified death, and 3) the role the physician ought to play in treating terminal patients. Protestant clergy more than their Catholic counterparts are substantially in favor of 1) disclosure of terminal illness, 2) allowing an easy death for the terminal patient at his request, and 3) facilitating the role of the physicians in cases of terminal illness. Fundamentalist Protestants are less approving than liberal Protestants. Clerics who saw their role extend beyond man's spiritual need approve of the physician's disclosure of terminal illness and his cooperation with patients who request with holding or terminating medical treatment. The Uterature abounds with reports of the role conflict medical professionals are increasingly experiencing in treating terminal patients. Technological advance, material costs, the moral and reUgious feelings of the patient, family pressure, and fear of legal risks aU create severe conflict for physicians.1 The two central functions of the medical profession are the struggle against death and disease and the aUeviation of pain and suffering.2 Medical education, with its lack of preparation for caring for the dying patient and its firm dedication to the Hippocratic Oath, interpreted as the saving of Ufe at any cost, is a major source of role conflict.3 The physician is in a quandary because he is expected both to ease suffering and to save Ufe.4 Currently, it appears that the medical imperative of sustaining aU Uves, regardless of costs, may be the more encompassing force acting on the physician.5 In fact, it seems as though death offends the medical profession.6 Unfortunately medical education does not provide adequate training to deal with various complicated problems connected with death. Physician surveys reveal that few doctors beUeve that their approach to the patient with terminal disease owes anything to medical training. Furthermore, doctors disagree markedly concerning what such patients should be told.7

Disclosure of Terminal Illness

Disclosure of Terminal Illness