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12.11.2020 | Original Article

Prevalence of ethical dilemmas in advanced cancer patients (secondary analysis of the PALCOM study)

verfasst von: Albert Tuca, Margarita Viladot, Carmen Barrera, Manoli Chicote, Irene Casablancas, Claudia Cruz, Elena Font, Javier Marco-Hernández, Joan Padrosa, Anais Pascual, Núria Codorniu, Begoña Román

Erschienen in: Supportive Care in Cancer | Ausgabe 7/2021

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Abstract

Purpose

The main aim of this study was to determine the prevalence of ethical dilemmas in the end-of-life process in advanced cancer patients.

Methods

We carried out a multicenter, cross-sectional, observational, prospective study in a cohort of cancer patients whose life expectancy was ≤ 6 months. We recorded sociodemographic characteristics, diagnosis of cancer, symptom burden, cognitive and functional status, emotional impact, and sociofamilial risk factors. The main outcome measure was the detection of ethical dilemmas, based on the following definition: conflict in decision-making during the end-of-life process that involves the need to choose between morally acceptable opposing options, where none is clearly preferable to another.

Results

We included 324 patients (mean age, 69 years; 58% men). We identified 117 dilemmas in 90 patients (27.8%). The dilemmas detected were as follows: (a) conflicts of information (adaptive denial, conspiracy of silence, information exceeding patient’s desired limit), 15.7%; (b) discrepancies in proportionality (discussion on futility, rejection of treatment, withdrawal of life support measures), 16.7%; (c) unrealistic expectations about the outcome of clinical trials, 2.5%; and (d) request for euthanasia or medically assisted suicide, 1.2%. We observed a greater prevalence of ethical dilemmas in men, in patients receiving active cancer treatment, and in patients with emotional distress (p < 0.05).

Conclusions

The prevalence of ethical dilemmas during the end-of-life process in cancer patients is relevant. Most dilemmas were associated directly or indirectly with respect for patient autonomy. In this context, the communication skills of the health professionals and advanced care planning take on a key role.

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Titel: Prevalence of ethical dilemmas in advanced cancer patients (secondary analysis of the PALCOM study)
verfasst von: Albert Tuca
Margarita Viladot
Carmen Barrera
Manoli Chicote
Irene Casablancas
Claudia Cruz
Elena Font
Javier Marco-Hernández
Joan Padrosa
Anais Pascual
Núria Codorniu
Begoña Román
Publikationsdatum: 12.11.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 7/2021
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-020-05885-0

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Prevalence of ethical dilemmas in advanced cancer patients (secondary analysis of the PALCOM study)