Palliative Care to Cancer Patients: The Effects of a Systematic Advance Care Planning on the Refusal of End of Life-Sustaining Treatment
Keywords:
End-of-Life, Cancer Patients, Systematic Advance Care Planning, Palliative Care, Refusal of Life-Sustaining TreatmentAbstract
The objectives of this quasi-experimental research were: 1) to compare the decision-making to refuse life-sustaining treatment between cancer patients who had received conventional palliative care and cancer patients who had received palliative care along with a systematic advance care planning, and 2) to compare the refusal of life-sustaining equipment/medication between experimental group and control group. The purposive sample was 60 cancer patients who received palliative care at Hatyai hospital from August 2019, to September 2020. The instruments were: 1) a questionnaire on end-of-life care needs, 2) a systematic advance care planning manual. Content validity was examined by 3 experts. Test-retest reliability was assessed in 20 palliative cancer patients, yielding a correlation coefficient of 0.91.
The results were as follows.
1. The cancer patients who received palliative care along with systematic advance care planning had statistically significant higher average scores on the refusal of life-sustaining treatment than patients who received the conventional care plan (t=-7.07 p<.001).
2. Participants from the experimental group refused higher than the control group, with statistical significance (p<.01 and p<.001), the endotracheal tube, isotropy medication, non-beneficial antibiotics or fluids, and inserting nasogastric tube. In addition, most of the participants from the experimental group statistically significantly expressed the desire to withdrawal life-sustaining treatment and to die at home, higher than the control group (p<.05 and p<.001, respectively).
Systematic care planning might be implemented with the agreement and collaboration from patients, so to avoid therapeutic obstinacy and, therefore, to improve quality of the end-of-life among cancer patients in palliative care units.
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