Talking with Patients about Dying Reply

New England Journal of Medicine (Impact Factor: 55.87). 10/2012; 367(17):1651-2. DOI: 10.1056/NEJMe1211160
Source: PubMed
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    Gerecht Sorgen. Verständigungsprozesse über einen gerechten Einsatz knapper Ressourcen bei Patienten am Lebensende, Edited by Gunnar Duttge, Markus Zimmermann-Acklin, 01/2013: chapter Zu alt für die Hüftprothese, zu jung zum Sterben? Die Rolle von Altersbildern in der ethisch-politischen Debatte um eine altersabhängige Begrenzung medizinischer Leistungen: pages 149-167; Göttingen University Press., ISBN: 978-3-86395-116-0
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    ABSTRACT: Objectives: This study aimed to explore the perceptions of the prognosis and goals of chemotherapy and to evaluate the differences in end-of-life outcomes between advanced non-small-cell lung cancer (NSCLC) patients with accurate perceptions and those with inaccurate perceptions. Methods: This was a longitudinal cohort study. A questionnaire regarding curability and eliminating all cancer was administered to 36 patients with advanced NSCLC who received at least first-line chemotherapy. The outcomes, including chemotherapy use and location of death, were also longitudinally assessed according to accurate or inaccurate perceptions of the prognosis and goals of chemotherapy. Results: The patients' perceptions were assessed at a median of 17.7 months from the initiation of chemotherapy. Fifty-six percent of the patients reported that their cancer was incurable. Only 38% of the patients answered in concordance with the perceptions that their cancer was not curable and that the goal of chemotherapy was not to eliminate all of their cancer. Among the 19 patients who died during follow-up, the median number of days between the last dose of chemotherapy and death and the overall survival did not differ significantly between the patients with accurate perceptions and those with inaccurate perceptions. The patients with accurate perceptions were more likely to discuss their wishes for chemotherapy discontinuation with a physician (64% versus 38%) compared with those with inaccurate perceptions. Moreover, the patients with accurate perceptions were more likely to die in a palliative care unit (31% versus 0%, P = 0.055) than those with inaccurate perceptions. Conclusions: Many patients with advanced NSCLC may misunderstand their prognosis and the goals of chemotherapy, which leads to inappropriate decision-making regarding end-of-life care.
    Haigan 01/2013; 53(6):745-750. DOI:10.2482/haigan.53.745
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    ABSTRACT: Palliative care is cited as providing improved communication, symptom control, treatment knowledge, and survival. The authors feel primary palliative care skills should be part of a physician's armamentarium.
    Journal of Oncology Practice 03/2013; 9(2):84-8. DOI:10.1200/JOP.2013.000885
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