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Patient involvement in decisions to limit treatment: the crucial role of agreement between physician and patient
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID 4607146
Author(s) Winkler, Eva C.; Reiter-Theil, Stella; Lange-Riess, Dorothee; Schmahl-Menges, Nina; Hiddemann, Wolfgang
Author(s) at UniBasel Reiter-Theil, Stella
Year 2009
Title Patient involvement in decisions to limit treatment: the crucial role of agreement between physician and patient
Journal Journal of Clinical Oncology
Volume 27
Number 13
Pages / Article-Number 2225-30
Mesh terms Adult; Aged; Aged, 80 and over; Decision Making; Female; Humans; Male; Middle Aged; Neoplasms, therapy; Patient Participation; Patient Satisfaction; Physician-Patient Relations; Prospective Studies; Terminal Care; Withholding Treatment
Abstract The aim of this study was to describe, first, the decision-making process concerning the limitation of life-prolonging treatment (DLT); second, the extent to which patients are actually involved in these decisions; and third, to detect medical and ethical factors that affect patient involvement. This prospective qualitative study enrolled 76 patients with incurable cancer with whom the limitation of life-prolonging treatment was discussed. Embedded researchers on the wards recorded the patient's history, medical condition, type of treatment limitation discussed, patient wishes, decision-making capacity, and patient involvement using an in-depth documentation procedure. While the majority of patients were informed about their diagnosis, therapy, and course of disease (99%, 97%, 90%, respectively), only 47% were involved in DLT. Two thirds of the patients preferred palliative care, and one third wished to extend their lifetime. If patients preferred palliative care, they were more often in line with physicians' treatment goals than patients who were striving for longer survival (91.4% v 46.7%; P = .001). They also were involved significantly more often in DLT. Multivariate analysis showed that age, Karnofsky performance index or decision-making capacity had no impact on patient involvement. Only half of the patients were involved in DLT. Surprisingly, the main predictor of patient involvement was not their medical condition, but agreement with physicians' palliative treatment goals. These results show that if physicians switch to comfort care in terminally ill patients and patients are not yet prepared to follow this line, treatment limitations are often decided without involving the patient.
Publisher American Society of Clinical Oncology
ISSN/ISBN 0732-183X ; 1527-7755
Full Text on edoc No
Digital Object Identifier DOI 10.1200/JCO.2008.17.9515
PubMed ID
ISI-Number WOS:000266195000019
Document type (ISI) Journal Article

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