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Supportive Care in Cancer

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Open Access 01-10-2020 | Care | Original Article

Let us talk about death: gender effects in cancer patients’ preferences for end-of-life discussions

Authors: C. Seifart, J. Riera Knorrenschild, M. Hofmann, Y. Nestoriuc, W. Rief, P. von Blanckenburg

Published in: Supportive Care in Cancer | Issue 10/2020

Abstract

Purpose

Patients with advanced cancer often receive suboptimal end-of-life (EOL) care. Particularly males with advanced cancer are more likely to receive EOL care that is more aggressive, even if death is imminent. Critical factors determining EOL care are EOL conversations or advance care planning. However, information about gender-related factors influencing EOL conversations is lacking. Therefore, the current study investigates gender differences concerning the content, the desired time point, and the mode of initiation of EOL conversations in cancer patients.

Methods

In a cross-sectional study, 186 female and male cancer patients were asked about their preferences for EOL discussions using a semi-structured interview, focusing on (a) the importance of six different topics (medical and nursing care, organizational, emotional, social, and spiritual/religious aspects), (b) the desired time point, and (c) the mode of discussion initiation.

Results

The importance of EOL topics differs significantly regarding issue (p = 0.002, η² = 0.02) and gender (p < 0.001, η² = 0.11). Males wish to avoid the engagement in discussions about death and dying particularly if they are anxious about their end-of-life period. They wish to be addressed regarding the “hard facts” nursing and medical care only. In contrast, females prefer to speak more about “soft facts” and to be addressed about each EOL topic. Independent of gender, the majority of patients prefer to talk rather late: when the disease is getting worse (58%), at the end of their therapy, or when loosing self-sufficiency (27.5%).

Conclusion

The tendency of patients to talk late about EOL issues increases the risk of delayed or missed EOL conversations, which may be due to a knowledge gap regarding the possibility of disease-associated incapability. Furthermore, there are significant gender differences influencing the access to EOL conversations. Therefore, for daily clinical routine, we suggest an early two-step, gender-sensitive approach to end-of-life conversations.

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Title: Let us talk about death: gender effects in cancer patients’ preferences for end-of-life discussions
Authors: C. Seifart
J. Riera Knorrenschild
M. Hofmann
Y. Nestoriuc
W. Rief
P. von Blanckenburg
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keyword: Care
Published in: Supportive Care in Cancer / Issue 10/2020
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-019-05275-1

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