Skip to main content
SpringerLink
Log in

End-of-life decision-making of terminally ill cancer patients in a tertiary cancer center in Shanghai, China

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Different countries have various decision-making practices, which are formalized according to laws, rules, traditions, religious beliefs, and ethical views of different cultural backgrounds. We investigated the characteristics and factors associated with the decision-making details in terminally ill cancer patients in a tertiary cancer center in Shanghai, China.

Method

A single center, retrospective study was performed among advanced cancer patients who died between March 2007 and December 2013 in ward at Palliative Care Unit, Fudan University Shanghai Cancer Center.

Results

Of 436 patients’ end-of-life (EOL) discussions, 424 (97.2 %) occurred between family caregivers and physicians. The main decision-maker was in the following order: spouse (45.6 %), offsprings (44.3 %), parents (3.2 %), son-/daughter-in-law (1.8 %), and relatives (1.4 %). Two hundred twenty-one (47.3 %) patients received at least one of six life-sustaining treatments. One hundred eighty-four (40.4 %) patients continued artificial nutrition and hydration (ANH) until death. Cardiopulmonary resuscitation (CPR) was performed in 26 patients (6.0 %). Two hundred fourteen (49.1 %) patients received vasopressors before death. Only two patients received mechanical ventilation and only one patient received tracheostomy. The median time interval since the decision made till death was 20.17 h (95 % CI = 18.94–21.40, range 4.3 to 70.2 h). Patients who were older than 65 years old were less likely to undergo an intensive procedure (AOR = 0.559, 95 % CI = 0.367–0.852, p = 0.007). Patients living in urban settings (AOR = 2.177, 95 % CI = 1.398–3.390, p = 0.001) were more likely to undergo an intensive procedure in the EOL period.

Conclusions

This study reflected some Chinese characteristics for decision-making at the end of life among advanced cancer patients. More prospective studies focused on specific EOL issues are required to improve the quality of EOL care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Yaguchi A, Truog RD, Curtis JR, Luce JM, Levy MM, Melot C, Vincent JL (2005) International differences in end-of-life attitudes in the intensive care unit-results of a survey. Arch Intern Med 165(17):1970–1975

    Article  PubMed  Google Scholar 

  2. Kumar P, Temel JS (2013) End-of-life care discussions in patients with advanced cancer. J Clin Oncol 31(27):3315–3319

    Article  PubMed  Google Scholar 

  3. Wright AA, Zhang BH, Ray A et al (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA J Am Med Assoc 300(14):1665–1673

    Article  CAS  Google Scholar 

  4. Chiu TY, Ho WY, Chen CY (2000) Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan. Support Care Cancer 8(4):311–313

    Article  CAS  PubMed  Google Scholar 

  5. Wallberg B, Michelson H, Nystedt M, Bolund C, Degner LF, Wilking N (2000) Information needs and preferences for participation in treatment decisions among Swedish breast cancer patients. Acta Oncol 39(4):467–476

    Article  CAS  PubMed  Google Scholar 

  6. van der Heide A, Deliens L, Faisst K et al (2003) End-of-life decision-making in six European countries: descriptive study. Lancet 362(9381):345–350

    Article  PubMed  Google Scholar 

  7. Richer MC, Ezer H (2000) Understanding beliefs and meanings in the experience of cancer: a concept analysis. J Adv Nurs 32(5):1108–1115

    Article  CAS  PubMed  Google Scholar 

  8. Kae-Hwa J, Gyeong-Ju A (2013) Factors affecting shared decision making at end of life in Korean adults. Holist Nurs Pract 27(6):329–335

    Article  Google Scholar 

  9. Phua J, Kee AC-L, Tan A et al (2011) End-of-life care in the general wards of a Singaporean hospital: an Asian perspective. J Palliat Med 14(12):1296–1301

    Article  PubMed  Google Scholar 

  10. Ivo K, Younsuck K, Ho YY et al (2012) A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan. J Med Ethics 38(5):310–316

    Article  PubMed  Google Scholar 

  11. Mo HN, Shin DW, Woo JH et al (2012) 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(3):222–231

    Article  PubMed  Google Scholar 

  12. 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):296–301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Bowman KW, Singer PA (2001) Chinese seniors’ perspectives on end-of-life decisions. Soc Sci Med 53(4):455–464

    Article  CAS  PubMed  Google Scholar 

  14. Huang HS, Liu HJ, Zeng TY, Pu XM (2015) Preference of Chinese general public and healthcare providers for a good death. Nurs Ethics 22(2):217–227

    Article  Google Scholar 

  15. Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA (2000) Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA 284(19):2476–2482

    Article  CAS  PubMed  Google Scholar 

  16. Mitchell SL, Teno JM, Kiely DK et al (2009) The clinical course of advanced dementia. NEJM 361(16):1529–1538

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Kao C-Y, Cheng S-Y, Chiu T-Y, Chen C-Y, Hu W-Y (2013) Does the awareness of terminal illness influence cancer patients psycho-spiritual state, and their DNR signing: a survey in Taiwan. Jpn J Clin Oncol 43(9):910–916

    Article  PubMed  Google Scholar 

  18. 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):336–340

    Article  PubMed  Google Scholar 

  19. Liu JM, Lin WC, Chen YM et al (1999) The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre. J Med Ethics 25(4):309–314

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kwak J, Haley WE (2005) Current research findings on end-of-life decision making among racially or ethnically diverse groups. Gerontologist 45(5):634–641

    Article  PubMed  Google Scholar 

  21. Fan R (2002) Reconsidering surrogate decision making: Aristotelianism and Confucianism on ideal human relations. Philos East West 52(3):346–372

    Article  PubMed  Google Scholar 

  22. Kagawa-Singer M, Blackhall LJ (2001) Negotiating cross-cultural issues at the end of life—“You got to go where he lives”. JAMA J Am Med Assoc 286(23):2993–3001

    Article  CAS  Google Scholar 

  23. Oh DY, Kim JH, Kim DW et al (2006) CPR or DNR? End-of-life decision in Korean cancer patients: a single center’s experience. Support Care Cancer 14(2):103–108

    Article  PubMed  Google Scholar 

  24. Bruera E, Hui D, Dalal S et al (2013) Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol 31(1):111–118

    Article  PubMed  Google Scholar 

  25. Nakajima N, Satake N, Nakaho T (2014) Indications and practice of artificial hydration for terminally ill cancer patients. Curr Opin Support Palliat Care 8(4):358–363

    Article  PubMed  Google Scholar 

  26. Chiu TY, Hu WT, Chang RB et al (2002) Nutrition and hydration for terminal cancer patients in Taiwan. Support Care Cancer 10(8):630–636

    Article  PubMed  Google Scholar 

  27. Manalo MFC (2013) End-of-life decisions about withholding or withdrawing therapy: medical, ethical, and religio-cultural considerations. Palliat Care 10(7):1–5

    Google Scholar 

  28. Chiu TY, Hu WY, Chuang RB, Cheng YR, Chen CY, Wakai S (2004) Terminal cancer patients’ wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan. J Pain Symptom Manag 27(3):206–214

    Article  Google Scholar 

  29. Diaz-Montes TP, Johnson MK, Giuntoli RL II, Brown AJ (2013) Importance and timing of end-of-life care discussions among gynecologic oncology patients. Am J Hosp Palliat Care 30(1):59–67

    Article  PubMed  Google Scholar 

  30. Keating NL, Landrum MB, Jr RS et al (2010) Physician factors associated with discussions about end-of-life care. Cancer 116(4):998–1006

    Article  PubMed  PubMed Central  Google Scholar 

  31. Morita T, Tsunoda J, Inoue S, Chihara S (1999) Perceptions and decision-making on rehydration of terminally ill cancer patients and family members. Am J Hosp Palliat Care 16(3):509–516

    Article  CAS  PubMed  Google Scholar 

  32. Wilson ME, Samirat R, Yilmaz M, Gajic O, Iyer VN (2013) Physician staffing models impact the timing of decisions to limit life support in the ICU. Chest 143(3):656–663

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Integrated Therapy, Fudan University Shanghai Cancer Center, #270, DongAn Road, Shanghai, People’s Republic of China

    Xiaoli Gu, Menglei Chen, Minghui Liu, Zhe Zhang & Wenwu Cheng

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Xiaoli Gu, Menglei Chen, Minghui Liu, Zhe Zhang & Wenwu Cheng

Authors
  1. Xiaoli Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Menglei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Minghui Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhe Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wenwu Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wenwu Cheng.

Ethics declarations

Compliance with ethical standards

Approval to conduct this study was obtained from the FUSCC Ethics Review Board. As all the data assessed in this study were obtained as part of routine clinical assessments from the patients’ medical records, written consent for this study was not obtained from the patients, in accordance with the guidelines of the Chinese Ministry of Health.

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gu, X., Chen, M., Liu, M. et al. End-of-life decision-making of terminally ill cancer patients in a tertiary cancer center in Shanghai, China. Support Care Cancer 24, 2209–2215 (2016). https://doi.org/10.1007/s00520-015-3017-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-3017-x

Keywords

Search

Navigation