Preferences of advanced cancer patients for communication on anticancer treatment cessation and the transition to palliative care

• Published in: Cancer 2015-12, Vol.121 (23), p.4240-4249
• Main Authors: Umezawa, Shino, Fujimori, Maiko, Matsushima, Eisuke, Kinoshita, Hiroya, Uchitomi, Yosuke
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Communication; Cross-Sectional Studies; empathy; Female; Health Surveys; Humans; Japan; life expectancy; Male; Middle Aged; neoplasms; Neoplasms - pathology; Neoplasms - psychology; palliative care; Palliative Care - psychology; patient preference; Patient Preference - statistics & numerical data; Patients - psychology; Physician-Patient Relations; Prognosis; Regression Analysis; treatment failure; Withholding Treatment
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.29635

BACKGROUND The objective of this study was to clarify the communication preferences of patients with advanced cancer regarding discussions about ending anticancer treatment and transitioning to palliative care and to explore the variables associated with those preferences. METHODS Participants were 106 Japanese patients with cancer who had been informed at least 1 week earlier about the cessation of their anticancer treatment. They completed a survey measuring their preferences for communication about ending anticancer treatment and transitioning to palliative care as well as their demographic characteristics. Medical records were also examined to investigate medical characteristics. RESULTS Results of the descriptive analysis indicated that patients strongly preferred their physicians to listen to their distress and concerns (96%), to assure them that their painful symptoms would be controlled (97.1%), and to explain the status of their illness and the physical symptoms that would likely occur in the future (95.1%). Multiple regression analyses identified the factors associated with these preferences: telling patients to prepare mentally and informing them of their expected life expectancy were associated with cancer site; sustaining hope was associated with cancer site and children; and empathic paternalism was associated with duration since cancer diagnosis. CONCLUSIONS The majority of patients preferred their physicians to be realistic about their likely future and wanted to be reassured that their painful symptoms would be controlled. For patients with cancer at certain sites, those with children, and those more recently diagnosed, physicians should communicate carefully and actively by providing information on life expectancy and mental preparation, sustaining hope, and behaving with empathic paternalism. Cancer 2015;121:4240–4249. © 2015 American Cancer Society. The majority of patients with advanced cancer prefer physicians to be realistic about their likely future and want to be reassured that their painful symptoms will be controlled. For patients with cancer at certain sites, those with children, and those more recently diagnosed, physicians should communicate carefully and actively by providing information on life expectancy and mental preparation, sustaining hope, and behaving with empathic paternalism. See also pages 000‐000.