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Medical decisions concerning the end of life for cancer patients in three Colombian hospitals – a survey study

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dc.contributor.authorDe Vries, Esther
dc.contributor.authorLeal Arenas, Fabián Alexander
dc.contributor.authorDer Heide, Agnes van
dc.contributor.authorGempeler Rueda, Fritz E.
dc.contributor.authorMurillo, Raul
dc.contributor.authorMorales, Olga Lucía
dc.contributor.authorDiaz‑Amado, Eduardo
dc.contributor.authorRodríguez, Nelcy
dc.contributor.authorGonzalez, Beatriz Juliana
dc.contributor.authorCastilblanco Delgado, Danny Steven
dc.contributor.authorCalvache, Jose A.
dc.contributor.corporatenamePontificia Universidad Javeriana. Facultad de Medicina. Departamento de Anestesiologíaspa
dc.contributor.corporatenamePontificia Universidad Javeriana. Facultad de Medicina. Departamento de Epidemiología Clínica y Bioestadísticaspa
dc.date.accessioned2022-02-08T17:38:35Z
dc.date.available2022-02-08T17:38:35Z
dc.date.created2021-10-18
dc.description.abstractBackground 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. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods Cancer 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. Results Decisions 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. Conclusions Decisions 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 investigatedspa
dc.description.abstractenglishBackground 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. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods Cancer 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. Results Decisions 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. Conclusions Decisions 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 investigatedspa
dc.description.indexingRevista Internacional - Indexadaspa
dc.formatPDFspa
dc.format.mimetypeapplication/pdfspa
dc.identifierhttps://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00853-9spa
dc.identifier.doihttps://doi.org/10.1186/s12904-021-00853-9spa
dc.identifier.instnameinstname:Pontificia Universidad Javerianaspa
dc.identifier.issn1472-684Xspa
dc.identifier.reponamereponame:Repositorio Institucional - Pontificia Universidad Javerianaspa
dc.identifier.repourlrepourl:https://repository.javeriana.edu.cospa
dc.identifier.urihttp://hdl.handle.net/10554/59014
dc.language.isoengspa
dc.relation.ispartofjournalBMC Palliative Carespa
dc.rights.coarhttp://purl.org/coar/access_right/c_abf2spa
dc.rights.licenceAtribución-NoComercial 4.0 Internacional*
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/*
dc.subjectFin de vidaspa
dc.subjectCuidados paliativosspa
dc.subjectToma de decisionesspa
dc.subjectDecision médicaspa
dc.subjectColombiaspa
dc.subjectCancerspa
dc.subjectEutanasiaspa
dc.subjectSedación paliativaspa
dc.subject.keywordEnd of lifespa
dc.subject.keywordPalliative carespa
dc.subject.keywordDecision makingspa
dc.subject.keywordMedical decisionspa
dc.subject.keywordColombiaspa
dc.subject.keywordCancerspa
dc.subject.keywordEuthanasiaspa
dc.subject.keywordPalliative sedationspa
dc.titleMedical decisions concerning the end of life for cancer patients in three Colombian hospitals – a survey studyspa
dc.title.englishMedical decisions concerning the end of life for cancer patients in three Colombian hospitals – a survey studyspa
dc.type.coarhttp://purl.org/coar/resource_type/c_2df8fbb1spa
dc.type.hasversionhttp://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.localArtículo de revistaspa

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