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Supportive Care in Cancer
Published in: Supportive Care in Cancer 1/2013

01-01-2013 | Original Article

Surrogate decision-making in Korean patients with advanced cancer: a longitudinal study

Authors: June Koo Lee, Bhumsuk Keam, Ah Reum An, Tae Min Kim, Se-Hoon Lee, Dong-Wan Kim, Dae Seog Heo

Published in: Supportive Care in Cancer | Issue 1/2013

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Abstract

Purpose

Although surrogate decision-making in cancer patients is well-known, few studies investigating the prevalence of surrogate decision-making over time have been reported. The objectives of this study were to investigate the level of surrogate decision-making in advanced cancer patients over time and the impact of demographic and clinical variables on surrogate decision-making.

Methods

The level of surrogate decision-making was measured in 572 consecutive cancer patients who died between January 1 and December 31, 2009. We reviewed 8,639 informed consent forms of these patients, calculated the proportion of decisions made by a surrogate (PDS) for each patient, and analyzed the association of PDS with demographic and clinical variables.

Results

Surrogates completed 40.3 % of all consent forms. The prevalence of surrogate decision-making was higher in the end-of-life period (death <7 days, OR = 29.05; reference, >365 days). Surrogates signed consent forms more frequently for do-not-resuscitate directives, intensive care unit admission, emergency hemodialysis, surgery and invasive interventions compared with chemotherapy, radiotherapy, and diagnostic tests (OR = 3.88, P < 0.001). Patients of older age (P = 0.036) and those with a shorter duration of management (P < 0.001) were independently associated with greater PDS.

Conclusions

Surrogate decision-making was frequently observed among Korean cancer patients in this study, especially when the patient’s death was imminent, and for decisions related to end-of-life care. Surrogates were also frequently involved in decisions for elderly or rapidly deteriorating patients. Healthcare professionals should consider the significant role of familial surrogates in the end-of-life period; comprehensive approaches are needed to preserve the best interest of the patients.
Literature
1.
Paterick TJ, Carson GV, Allen MC, Paterick TE (2008) Medical informed consent: general considerations for physicians. Mayo Clin Proc 83:313–319PubMedCrossRef
2.
Chiu TY, Hu WY, Chen CY (2000) Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan. Supp Care Cancer 8(4):311–313CrossRef
3.
Raymont V, Bingley W, Buchanan A, David AS, Hayward P, Wessely S, Hotopf M (2004) Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study. Lancet 364(9443):1421–1427PubMedCrossRef
4.
Silveira MJ, Kim SYH, Langa KM (2010) Advance directives and outcomes of surrogate decision making before death. N Engl J Med 362(13):1211–1218PubMedCrossRef
5.
Smedira NG, Evans BH, Grais LS, Cohen NH, Lo B, Cooke M, Schecter WP, Fink C, Epstein-Jaffe E, May C (1990) Withholding and withdrawal of life support from the critically ill. N Engl J Med 322(5):309–315PubMedCrossRef
6.
Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere K, O'Neil J, Bilodeau B, Watson P, Mueller B (1997) Information needs and decisional preferences in women with breast cancer. JAMA 277(18):1485PubMedCrossRef
7.
Akabayashi A, Fetters MD, Elwyn TS (1999) Family consent, communication, and advance directives for cancer disclosure: a Japanese case and discussion. J Med Ethics 25(4):296–301PubMedCrossRef
8.
Galambos CM (1998) Preserving end-of-life autonomy: the patient self-determination act and the uniform health care decisions act. Health Soc Work 23(November)
9.
Berger JT, DeRenzo EG, Schwartz J (2008) Surrogate decision making: reconciling ethical theory and clinical practice. Ann Intern Med 149(1):48–53PubMed
10.
Tang ST, Liu TW, Lai MS, Liu LN, Chen CH (2005) Concordance of preferences for end-of-life care between terminally ill cancer patients and their family caregivers in Taiwan. J Pain Symptom Manage 30(6):510–518PubMedCrossRef
11.
Shalowitz DI, Garrett-Mayer E, Wendler D (2006) The accuracy of surrogate decision makers: a systematic review. Arch Intern Med 166(5):493PubMedCrossRef
12.
Jecker NS, Schneiderman LJ (1995) When families request that ‘everything possible’ be done. J Med Philos 20(2):145–163PubMedCrossRef
13.
Hauke D, Reiter-Theil S, Hoster E, Hiddemann W, Winkler E (2011) The role of relatives in decisions concerning life-prolonging treatment in patients with end-stage malignant disorders: informants, advocates or surrogate decision-makers? Ann Oncol 22:2667–2674PubMedCrossRef
14.
An AR, Yun YH, Lee W, Jung K, Do Y (2011) Do the preferences of patients with terminal cancer or their family caregivers and end-of-life care discussions influence utilization of hospice-palliative care? J Clin Oncol: 2011 ASCO annual meeting proceedings 29:15S–599s
15.
Lamont EB, Siegler M (2000) Paradoxes in cancer patients' advance care planning. J Palliat Med 3(1):27–35PubMedCrossRef
16.
Go RS, Hammes BA, Lee JA, Mathiason MA (2007) Advance directives among health care professionals at a community-based cancer center. Mayo Clin Proc 82:1487–1490PubMedCrossRef
17.
18.
Oh DY, Kim JH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Kim NK (2006) CPR or DNR? End-of-life decision in Korean cancer patients: a single center’s experience. Supp Care Cancer 14(2):103–108CrossRef
19.
Sato K, Miyashita M, Morita T, Sanjo M, Shima Y, Uchitomi Y (2008) Quality of end-of-life treatment for cancer patients in general wards and the palliative care unit at a regional cancer center in Japan: a retrospective chart review. Supp Care Cancer 16(2):113–122CrossRef
20.
Huang CH, Hu WY, Chiu TY, Chen CY (2008) The practicalities of terminally ill patients signing their own DNR orders—a study in Taiwan. J Med Ethics 34(5):336PubMedCrossRef
21.
Levin TT, Li Y, Weiner JS, Lewis F, Bartell A, Piercy J, Kissane DW (2008) How do-not-resuscitate orders are utilized in cancer patients: timing relative to death and communication-training implications. Palliat Supp Care 6(04):341–348CrossRef
22.
Gleeson K (1990) The do-not-resuscitate order: still too little too late. Arch Intern Med 150(5):1057PubMedCrossRef
23.
Van der Heide A, Deliens L, Faisst K, Nilstun T, Norup M, Paci E, van der Wal G, van der Maas PJ (2003) End-of-life decision-making in six European countries: descriptive study. Lancet 362(9381):345–350PubMedCrossRef
24.
Fan R (1997) Self-determination vs. family-determination: two incommensurable principles of autonomy. Bioethics 11(3–4):309–322PubMedCrossRef
25.
Bülow HH, Sprung CL, Reinhart K, Prayag S, Du B, Armaganidis A, Abroug F, Levy MM (2008) The world's major religions' points of viewon end-of-life decisionsin the intensive care unit. Intensive Care Med 34(3):423–430PubMedCrossRef
26.
Blackhall LJ, Frank G, Murphy S, Michel V (2001) Bioethics in a different tongue: the case of truth-telling. J Urban Health 78(1):59–71PubMedCrossRef
27.
Mo HN, Shin DW, Woo JH, Choi JY, Kang J, Baik YJ, Huh YR, Won JH, Park MH, Cho SH (2011) Is patient autonomy a critical determinant of quality of life in Korea? End-of-life decision making from the perspective of the patient. Palliat Med 26:222–231PubMedCrossRef
28.
Kwak J, Salmon JR (2007) Attitudes and preferences of Korean–American older adults and caregivers on end-of-life care. J Am Geriat Soc 55(11):1867–1872PubMedCrossRef
29.
Yun YH, Lee CG, Kim S, Lee S, Heo DS, Kim JS, Lee KS, Hong YS, Lee JS, You CH (2004) The attitudes of cancer patients and their families toward the disclosure of terminal illness. J Clin Oncol 22(2):307–314PubMedCrossRef
30.
Heo DS (2009) Patient autonomy and advance directives in Korea. J Kor Med Assoc 52(9):865–870CrossRef
31.
Ende J, Kazis L, Ash A, Moskowitz MA (1989) Measuring patients’ desire for autonomy. J Gen Intern Med 4(1):23–30PubMedCrossRef
32.
Arora NK, McHorney CA (2000) Patient preferences for medical decision making: who really wants to participate? Med Care 38(3):335PubMedCrossRef
33.
Catalan J, Brener N, Andrews H, Day A, Cullum S, Hooker M, Gazzard B (1994) Whose health is it? Views about decision-making and information-seeking from people with HIV infection and their professional carers. AIDS Care 6(3):349–356PubMedCrossRef
34.
Blanchard CG, Labrecque MS, Ruckdeschel JC, Blanchard EB (1988) Information and decision-making preferences of hospitalized adult cancer patients. Soc Sci Med 27(11):1139–1145PubMedCrossRef
35.
Stiggelbout AM, Kiebert GM (1997) A role for the sick role: patient preferences regarding information and participation in clinical decision-making. CMAJ 157(4):383PubMed
36.
Jenkins V, Fallowfield L, Saul J (2001) Information needs of patients with cancer: results from a large study in UK cancer centres. Brit J Cancer 84(1):48PubMedCrossRef
37.
Puchalski CM, Zhong Z, Jacobs MM, Fox E, Lynn J, Harrold J, Galanos A, Phillips RS, Califf R, Teno JM (2000) Patients who want their family and physician to make resuscitation decisions for them: observations from support and help. study to understand prognoses and preferences for outcomes and risks of treatment. Hospitalized elderly longitudinal project. J Am Geriat Soc 48 (5 Suppl):S84
38.
Repetto L, Piselli P, Raffaele M, Locatelli C (2009) Communicating cancer diagnosis and prognosis: when the target is the elderly patient-a GIOGer study. Eur J Cancer 45(3):374–383PubMedCrossRef
39.
Chouliara Z, Kearney N, Stott D, Molassiotis A, Miller M (2004) Perceptions of older people with cancer of information, decision making and treatment: a systematic review of selected literature. Ann Oncol 15(11):1596PubMedCrossRef
40.
Bruera E, Sweeney C, Calder K, Palmer L, Benisch-Tolley S (2001) Patient preferences versus physician perceptions of treatment decisions in cancer care. J Clin Oncol 19(11):2883PubMed
41.
Bruera E, Willey JS, Lynn Palmer J, Rosales M (2002) Treatment decisions for breast carcinoma. Cancer 94(7):2076–2080PubMedCrossRef
42.
Yun YH, Han KH, Park S, Park BW, Cho CH, Kim S, Lee DH, Lee SN, Lee ES, Kang JH (2011) Attitudes of cancer patients, family caregivers, oncologists and members of the general public toward critical interventions at the end of life of terminally ill patients. CMAJ 183(10):E673–E679PubMedCrossRef
43.
Sonnenblick M, Friedlander Y, Steinberg A (1993) Dissociation between the wishes of terminally ill parents and decisions by their offspring. J Am Geriatr Soc 41(6):599–604PubMed
44.
Statistics Korea (2011) Death statistics in 2010. Statistics Korea [in Korean], Daejeon
45.
Perkins HS (2007) Controlling death: the false promise of advance directives. Ann Intern Med 147(1):51–57PubMed
46.
Sabatino CP (2010) The evolution of health care advance planning law and policy. Milbank Q 88(2):211–239PubMedCrossRef
47.
Hickman SE, Sabatino CP, Moss AH, Nester JW (2008) The POLST (Physician Orders for Life-Sustaining Treatment) paradigm to improve end-of-life care: potential state legal barriers to implementation. J Law Med Ethics 36(1):119–140PubMedCrossRef
48.
Eguchi K (2010) Development of palliative medicine for cancer patients in Japan: from isolated voluntary effort to integrated multidisciplinary network. Jpn J Clin Oncol 40(9):870–875PubMedCrossRef
49.
Higuchi N (2008) The first national guideline on terminal care and withdrawal of treatment in Japan. Clin Oncol 2 (4):370–374 [in Japanese]
Metadata
Title
Surrogate decision-making in Korean patients with advanced cancer: a longitudinal study
Authors
June Koo Lee
Bhumsuk Keam
Ah Reum An
Tae Min Kim
Se-Hoon Lee
Dong-Wan Kim
Dae Seog Heo
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 1/2013
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-012-1509-5

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