Decision making in the end-of-life care ofpatients who are terminally ill with cancer–a qualitative descriptive study with aphenomenological approach from theexperience of healthcare workers

Luna-Meza, Angela; Godoy-Casasbuenas, Natalia; Calvache, José Andrés; Díaz-Amado, Eduardo; Gempeler Rueda, Fritz E.; Morales, Olga; Leal, Fabian; Gómez-Restrepo, Carlos; de Vries, Esther

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dc.rights.licence	Atribución-NoComercial 4.0 Internacional	*
dc.contributor.author	Luna-Meza, Angela
dc.contributor.author	Godoy-Casasbuenas, Natalia
dc.contributor.author	Calvache, José Andrés
dc.contributor.author	Díaz-Amado, Eduardo
dc.contributor.author	Gempeler Rueda, Fritz E.
dc.contributor.author	Morales, Olga
dc.contributor.author	Leal, Fabian
dc.contributor.author	Gómez-Restrepo, Carlos
dc.contributor.author	de Vries, Esther
dc.coverage.spatial	Colombia	spa
dc.date.accessioned	2022-02-08T17:15:22Z
dc.date.available	2022-02-08T17:15:22Z
dc.date.created	2021-05-28
dc.identifier	https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00768-5	spa
dc.identifier.issn	1472-684X	spa
dc.identifier.uri	http://hdl.handle.net/10554/59010
dc.format	PDF	spa
dc.format.mimetype	application/pdf	spa
dc.language.iso	eng	spa
dc.rights.uri	http://creativecommons.org/licenses/by-nc/4.0/	*
dc.subject	Neoplasias	spa
dc.subject	Cuidado terminal	spa
dc.subject	Cuidados paliativos	spa
dc.subject	Muerte	spa
dc.subject	Colombia	spa
dc.title	Decision making in the end-of-life care ofpatients who are terminally ill with cancer–a qualitative descriptive study with aphenomenological approach from theexperience of healthcare workers	spa
dc.type.hasversion	http://purl.org/coar/version/c_ab4af688f83e57aa
dc.identifier.doi	https://doi.org/10.1186/s12904-021-00768-5	spa
dc.subject.keyword	Neoplasms	spa
dc.subject.keyword	Terminal care	spa
dc.subject.keyword	Palliative care	spa
dc.subject.keyword	Death	spa
dc.subject.keyword	Colombia	spa
dc.description.abstractenglish	Background: In Colombia, recent legislation regarding end-of-life decisions includes palliative sedation, advance directives and euthanasia. We analysed which aspects influence health professionals´ decisions regarding end-of-life medical decisions and care for cancer patients. Methods: Qualitative descriptive–exploratory study based on phenomenology using semi-structured interviews. We interviewed 28 oncologists, palliative care specialists, general practitioners and nurses from three major Colombian institutions, all involved in end-of-life care of cancer patients: Hospital Universitario San Ignacio and Instituto Nacional de Cancerología in Bogotá and Hospital Universitario San José in Popayan. Results: When making decisions regarding end-of-life care, professionals consider: 1. Patient’s clinical condition, cultural and social context, in particular treating indigenous patients requires special skills. 2. Professional skills and expertise: training in palliative care and experience in discussing end-of-life options and fear of legal consequences. Physicians indicate that many patients deny their imminent death which hampers shared decision-making and conversations. They mention frequent ambiguity regarding who initiates conversations regarding end-of-life decisions with patients and who finally takes decisions. Patients rarely initiate such conversations and the professionals normally do not ask patients directly for their preferences. Fear of confrontation with family members and lawsuits leads healthcare workers to carry out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in the absence of expected benefits. The opinions regarding the acceptability of palliative sedation, euthanasia and use of medications to accelerate death without the patients´ explicit request vary greatly. 3. Conditions of the insurance system: limitations exist in the offer of oncology and palliative care services for important proportions of the Colombian population. Colombians have access to opioid medications, barriers to their application are largely in delivery by the health system, the requirement of trained personnel for intravenous administration and ambulatory and home care plans which in Colombia are rare. Conclusions: To improve end-of-life decision making, Colombian healthcare workers and patients need to openly discuss wishes, needs and care options and prepare caregivers. Promotion of palliative care education and development of palliative care centres and home care plans is necessary to facilitate access to end-of-life care. Patients and caregivers’ perspectives are needed to complement physicians’ perceptions and practices.	spa
dc.type.local	Artículo de revista	spa
dc.contributor.corporatename	Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Anestesiología	spa
dc.contributor.corporatename	Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Epidemiología Clínica y Bioestadística	spa
dc.identifier.instname	instname:Pontificia Universidad Javeriana	spa
dc.identifier.reponame	reponame:Repositorio Institucional - Pontificia Universidad Javeriana	spa
dc.identifier.repourl	repourl:https://repository.javeriana.edu.co	spa
dc.type.coar	http://purl.org/coar/resource_type/c_beb9	spa
dc.description.orcid	https://orcid.org/0000-0002-6036-9155
dc.description.orcid	https://orcid.org/0000-0001-5527-3522
dc.relation.ispartofjournal	BMC Palliative Care	spa
dc.contributor.javerianateacher	Gempeler Rueda, Fritz E.
dc.contributor.javerianateacher	Morales, Olga
dc.description.indexing	Revista Internacional - Indexada	spa
dc.relation.citationvolume	20
dc.rights.coar	http://purl.org/coar/access_right/c_abf2	spa