Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Palliative Care
Published in: BMC Palliative Care 1/2020

01-12-2020 | Nutrition | Research article

Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study

Authors: Hsien-Liang Huang, Jaw-Shiun Tsai, Chien-An Yao, Shao-Yi Cheng, Wen-Yu Hu, Tai-Yuan Chiu

Published in: BMC Palliative Care | Issue 1/2020

Login to get access

Abstract

Background

Communication in do not resuscitate (DNR) and artificial nutrition and hydration (ANH) at the end of life is a key component of advance care planning (ACP) which is essential for patients with advanced cancer to have cares concordant with their wishes. The SOP model (Shared decision making with Oncologists and Palliative care specialists) aimed to increase the rate of documentation on the preferences for DNR and ANH in patients with advanced cancer.

Methods

The SOP model was implemented in a national cancer treatment center in Taiwan from September 2016 to August 2018 for patients with advanced cancer visiting the oncology outpatient clinic. The framework was based on the model of shared decision making as “choice talk” initiated by oncologists with “option talk” and “decision talk” conducted by palliative care specialists.

Results

Among 375 eligible patients, 255 patients (68%) participated in the model testing with the mean age of 68.5 ± 14.7 years (mean ± SD). Comparing to 52.3% of DNR documentation among patients with advanced cancer who died in our hospital, the rate increased to 80.9% (206/255) after the decision talk in our model. Only 6.67% (n = 17) of the participants documented their preferences on ANH after the model. A worse Eastern Cooperative Oncology Group Performance Status was the only statistically significant associating factor with a higher rate of DNR documentation in the multiple logistic regression model.

Conclusions

The SOP model significantly increased the rate of DNR documentation in patients with advanced cancer in this pilot study. Dissemination of the model could help the patients to receive care that is concordant with their wishes and be useful for the countries having laws on ACP.
Appendix
Available only for authorised users
Literature
1.
Levy MH, Smith T, Alvarez-Perez A, Back A, Baker JN, Block S, et al. Palliative care, version 1.2014. Featured updates to the NCCN guidelines. J Natl Compr Cancer Netw. 2014;12(10):1379–88.CrossRef
2.
Sudore RL, Heyland DK, Lum HD, Rietjens JAC, Korfage IJ, Ritchie CS, et al. Outcomes that define successful advance care planning: a Delphi panel consensus. J Pain Symptom Manag. 2018;55(2):245–55 e248.CrossRef
3.
Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. J Pain Symptom Manag. 2017;53(5):821–32 e821.CrossRef
4.
Narang AK, Wright AA, Nicholas LH. Trends in advance care planning in patients with Cancer: results from a National Longitudinal Survey. JAMA Oncol. 2015;1(5):601–8.PubMedPubMedCentralCrossRef
5.
Institute of Medicine: Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC, National Academies Press, 2014.
6.
Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(1):96–112.PubMedCrossRef
7.
Hoerger M, Greer JA, Jackson VA, Park ER, Pirl WF, El-Jawahri A, et al. Defining the elements of early palliative care that are associated with patient-reported outcomes and the delivery of end-of-life care. J Clin Oncol. 2018;36(11):1096–102.PubMedPubMedCentralCrossRef
8.
Bakitas MA, El-Jawahri A, Farquhar M, Ferrell B, Grudzen C, Higginson I, et al. The TEAM approach to improving oncology outcomes by incorporating palliative Care in Practice. J Oncol Pract. 2017;13(9):557–66.PubMedCrossRef
9.
Kumar P, Temel JS. End-of-life care discussions in patients with advanced cancer. J Clin Oncol. 2013;31(27):3315–9.PubMedCrossRef
10.
Lamont EB, Siegler M. Paradoxes in cancer patients' advance care planning. J Palliat Med. 2000;3(1):27–35.PubMedCrossRef
11.
Dow LA, Matsuyama RK, Ramakrishnan V, Kuhn L, Lamont EB, Lyckholm L, et al. Paradoxes in advance care planning: the complex relationship of oncology patients, their physicians, and advance medical directives. J Clin Oncol. 2010;28(2):299–304.PubMedCrossRef
12.
Emanuel EJ, Emanuel LL. The economics of dying. The illusion of cost savings at the end of life. N Engl J Med. 1994;330(8):540–4.PubMedCrossRef
13.
Fagerlin A, Schneider CE. Enough. The failure of the living will. Hast Cent Rep. 2004;34(2):30–42.CrossRef
14.
Hawkins NA, Ditto PH, Danks JH, Smucker WD. Micromanaging death: process preferences, values, and goals in end-of-life medical decision making. Gerontol. 2005;45(1):107–17.CrossRef
15.
El-Jawahri A, Podgurski LM, Eichler AF, Plotkin SR, Temel JS, Mitchell SL, et al. Use of video to facilitate end-of-life discussions with patients with cancer: a randomized controlled trial. J Clin Oncol. 2010;28(2):305–10.PubMedCrossRef
16.
17.
Bradley NM, Sinclair E, Danjoux C, Barnes EA, Tsao MN, Farhadian M, et al. The do-not-resuscitate order: incidence of documentation in the medical records of cancer patients referred for palliative radiotherapy. Curr Oncol. 2006;13(2):47–54.PubMedPubMedCentral
18.
Voogt E, van der Heide A, Rietjens JA, van Leeuwen AF, Visser AP, van der Rijt CC, et al. Attitudes of patients with incurable cancer toward medical treatment in the last phase of life. J Clin Oncol. 2005;23(9):2012–9.PubMedCrossRef
19.
Bestvina CM, Polite BN. Implementation of advance care planning in oncology: a review of the literature. J Oncol Pract. 2017;13(10):657–62.PubMedCrossRef
20.
Temel JS, Greer JA, Gallagher ER, Jackson VA, Lennes IT, Muzikansky A, et al. Electronic prompt to improve outpatient code status documentation for patients with advanced lung cancer. J Clin Oncol. 2013;31(6):710–5.PubMedCrossRef
21.
Obel J, Brockstein B, Marschke M, Robicsek A, Konchak C, Sefa M, et al. Outpatient advance care planning for patients with metastatic cancer: a pilot quality improvement initiative. J Palliat Med. 2014;17(11):1231–7.PubMedCrossRef
22.
Stein RA, Sharpe L, Bell ML, Boyle FM, Dunn SM, Clarke SJ. Randomized controlled trial of a structured intervention to facilitate end-of-life decision making in patients with advanced cancer. J Clin Oncol. 2013;31(27):3403–10.PubMedCrossRef
23.
Leng G, Clark CI, Brian K, Partridge G. National commitment to shared decision making. BMJ. 2017;359:j4746.PubMedCrossRef
24.
Levine DM, Landon BE, Linder JA. Trends in patient-perceived shared decision making among adults in the United States, 2002-2014. Ann Fam Med. 2017;15(6):552–6.PubMedPubMedCentralCrossRef
25.
Stiggelbout AM, Pieterse AH, De Haes JC. Shared decision making: concepts, evidence, and practice. Patient Educ Couns. 2015;98(10):1172–9.PubMedCrossRef
26.
Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681–92.PubMedCrossRef
27.
28.
Vanbutsele G, Pardon K, Van Belle S, Surmont V, De Laat M, Colman R, et al. Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial. Lancet Oncol. 2018;19(3):394–404.PubMedCrossRef
29.
Temel JS, Greer JA, El-Jawahri A, Pirl WF, Park ER, Jackson VA, et al. Effects of early integrated palliative Care in Patients with Lung and GI Cancer: a randomized clinical trial. J Clin Oncol. 2017;35(8):834–41.PubMedCrossRef
30.
Von Roenn JH. Advance care planning: ensuring that the patient's voice is heard. J Clin Oncol. 2013;31(6):663–4.CrossRef
31.
32.
Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891.PubMedPubMedCentralCrossRef
33.
Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.PubMedPubMedCentralCrossRef
34.
Joseph-Williams N, Newcombe R, Politi M, Durand MA, Sivell S, Stacey D, et al. Toward minimum standards for certifying patient decision aids: a modified Delphi consensus process. Med Decis Mak. 2014;34(6):699–710.CrossRef
35.
Lewis KB, Wood B, Sepucha KR, Thomson RG, Stacey D. Quality of reporting of patient decision aids in recent randomized controlled trials: a descriptive synthesis and comparative analysis. Patient Educ Couns. 2017;100(7):1387–93.PubMedCrossRef
36.
Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med. 2013;368(13):1173–5.PubMedCrossRef
37.
Chiu TY, Hu WY, Huang HL, Yao CA, Chen CY. Prevailing ethical dilemmas in terminal care for patients with cancer in Taiwan. J Clin Oncol. 2009;27(24):3964–8.PubMedCrossRef
38.
Huang HL, Yao CA, Hu WY, Cheng SY, Hwang SJ, Chen CD, et al. Prevailing ethical dilemmas encountered by physicians in terminal Cancer care changed after the enactment of the natural death act: 15 Years' follow-up survey. J Pain Symptom Manag. 2018;55(3):843–50.CrossRef
39.
McCann RM, Hall WJ, Groth-Juncker A. Comfort care for terminally ill patients. The appropriate use of nutrition and hydration. JAMA. 1994;272(16):1263–6.PubMedCrossRef
40.
Chiu TY, Hu WY, Chuang RB, Chen CY. Nutrition and hydration for terminal cancer patients in Taiwan. Support Care Cancer. 2002;10(8):630–6.PubMedCrossRef
41.
Chiu TY, Hu WY, Chuang RB, Cheng YR, Chen CY, Wakai S. Terminal cancer patients' wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan. J Pain Symptom Manag. 2004;27(3):206–14.CrossRef
42.
Morita T, Shima Y, Adachi I. Japan palliative oncology study G. attitudes of Japanese physicians toward terminal dehydration: a nationwide survey. J Clin Oncol. 2002;20(24):4699–704.PubMedCrossRef
43.
Ke LS, Chiu TY, Lo SS, Hu WY. Knowledge, attitudes, and behavioral intentions of nurses toward providing artificial nutrition and hydration for terminal cancer patients in Taiwan. Cancer Nurs. 2008;31(1):67–76.PubMedCrossRef
44.
Zheng RJ, Fu Y, Xiang QF, Yang M, Chen L, Shi YK, et al. Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China. Support Care Cancer. 2016;24(10):4097–103.PubMedPubMedCentralCrossRef
Metadata
Title
Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study
Authors
Hsien-Liang Huang
Jaw-Shiun Tsai
Chien-An Yao
Shao-Yi Cheng
Wen-Yu Hu
Tai-Yuan Chiu
Publication date
01-12-2020
Publisher
BioMed Central
Keywords
Nutrition
Care
Published in
BMC Palliative Care / Issue 1/2020
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-020-0521-7

Other articles of this Issue 1/2020

BMC Palliative Care 1/2020 Go to the issue

Correction

Correction to: An online international comparison of thresholds for triggering a negative response to the “Surprise Question”: a study protocol

Research article

Strengthening the spiritual domain in palliative care through a listening consultation service by spiritual caregivers in Dutch PaTz-groups: an evaluation study

Technical advance

Designing a Mission statement Mobile app for palliative care: an innovation project utilizing design-thinking methodology

Research article

Professional oral care in end-of-life patients with advanced cancers in a hospice ward: improvement of oral conditions

Research article

Exploring the costs, consequences and efficiency of three types of palliative care day services in the UK: a pragmatic before-and-after descriptive cohort study

Research article

Validation and cultural adaptation of the Integrated Palliative care Outcome Scale (IPOS) for the Portuguese population