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Preferences on the Timing of Initiating Advance Care Planning and Withdrawing Life-Sustaining Treatment between Terminally-Ill Cancer Patients and Their Main Family Caregivers: A Prospective Study

Author

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  • Cheng-Pei Lin

    (Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London SE5 9PJ, UK
    Institute of Community Health Care, School of Nursing, National Yang-Ming University, Taipei 112304, Taiwan)

  • Jen-Kuei Peng

    (Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei 100229, Taiwan)

  • Ping-Jen Chen

    (Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
    Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London W1T 7NF, UK)

  • Hsien-Liang Huang

    (Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei 100229, Taiwan)

  • Su-Hsuan Hsu

    (Department of Family Medicine, Taipei City Hospital, Taipei 10341, Taiwan)

  • Shao-Yi Cheng

    (Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei 100229, Taiwan)

Abstract

Background : The Western individualistic understanding of autonomy for advance care planning is considered not to reflect the Asian family-centered approach in medical decision-making. The study aim is to compare preferences on timing for advance care planning initiatives and life-sustaining treatment withdrawal between terminally-ill cancer patients and their family caregivers in Taiwan. Methods : A prospective study using questionnaire survey was conducted with both terminally-ill cancer patient and their family caregiver dyads independently in inpatient and outpatient palliative care settings in a tertiary hospital in Northern Taiwan. Self-reported questionnaire using clinical scenario of incurable lung cancer was employed. Descriptive analysis was used for data analysis. Results : Fifty-four patients and family dyads were recruited from 1 August 2019 to 15 January 2020. Nearly 80% of patients and caregivers agreed that advance care planning should be conducted when the patient was at a non-frail stage of disease. Patients’ frail stage of disease was considered the indicator for life-sustaining treatments withdrawal except for nutrition and fluid supplements, antibiotics or blood transfusions. Patient dyads considered that advance care planning discussions were meaningful without arousing emotional distress. Conclusion : Patient dyads’ preferences on the timing of initiating advance care planning and life-sustaining treatments withdrawal were found to be consistent. Taiwanese people’s medical decision-making is heavily influenced by cultural characteristics including relational autonomy and filial piety. The findings could inform the clinical practice and policy in the wider Asia–Pacific region.

Suggested Citation

  • Cheng-Pei Lin & Jen-Kuei Peng & Ping-Jen Chen & Hsien-Liang Huang & Su-Hsuan Hsu & Shao-Yi Cheng, 2020. "Preferences on the Timing of Initiating Advance Care Planning and Withdrawing Life-Sustaining Treatment between Terminally-Ill Cancer Patients and Their Main Family Caregivers: A Prospective Study," IJERPH, MDPI, vol. 17(21), pages 1-13, October.
  • Handle: RePEc:gam:jijerp:v:17:y:2020:i:21:p:7954-:d:437045
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    References listed on IDEAS

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    1. Sheng‐Yu Fan & Huei‐Chuan Sung & Shu‐Chen Wang, 2019. "The experience of advance care planning discussion among older residents in a long‐term care institution: A qualitative study," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(19-20), pages 3451-3458, October.
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    Cited by:

    1. Chih-Chieh Yen & Cheng-Pei Lin & Yu-Ting Su & Chiu-Hua Tsu & Li-Mei Chang & Zih-Jie Sun & Bing-Sheng Lin & Jin-Shang Wu, 2021. "The Characteristics and Motivations of Taiwanese People toward Advance Care Planning in Outpatient Clinics at a Community Hospital," IJERPH, MDPI, vol. 18(6), pages 1-14, March.
    2. Noorhazlina Ali & Philomena Anthony & Wee Shiong Lim & Mei Sian Chong & Edward Wing Hong Poon & Vicki Drury & Mark Chan, 2021. "Exploring Differential Perceptions and Barriers to Advance Care Planning in Dementia among Asian Patient–Caregiver Dyads—A Mixed-Methods Study," IJERPH, MDPI, vol. 18(13), pages 1-15, July.

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