What influences patients’ decisions about palliative care?

3rd September 2019

Advance care planning is widely adapted to support decision-making in advanced diseases.  However, the concept of advance care planning is largely derived from Western countries.  There has been little research about advance care planning in non-Western cultures.  The decision-making process and the reasons for choosing palliative care in non-Western cultures have received little attention.  Researchers based at the Cicely Saunders Institute decided to explore advance care planning from the perspective of advanced cancer patients, families and healthcare professionals in northern Taiwan.

They carried out semi-structured qualitative interviews with advanced care patients, families and healthcare professionals independently from inpatient oncology and hospice units.  Thematic analysis was carried out, including dual coding and an exploration of divergent views.

The researchers identified 3 main decision-making trajectories.

Choose palliative care was associated with a desire to reduce physical suffering from treatments, avoiding being a burden to families and society, remove futile treatments and donate organs to help others.  Decline palliative care was associated with patients weighing up perceived benefits to others as more important than benefits for themselves.  The third option identified was associated with lack of opportunity to discuss palliative care, due to a lack of staff skills in end of life communication, and cultural factors such as filial piety.

The researchers concluded that choice for palliative care among advanced cancer patients in Taiwan is influenced by three decision-making trajectories. Opinions from families are highly influential, and patients often lack information on palliative care options. Strategies to facilitate decision-making require staff confidence in end-of-life discussions, working with the patients and their families while respecting the influence of filial piety.

Lin CP, Evans CJ, Koffman J, Sheu SJ, Hsu SH, Harding R. What influences patients’ decisions regarding palliative care in advance care planning discussions? Perspectives from a qualitative study conducted with advanced cancer patients, families and healthcare professionals. Palliat Med. 2019:269216319866641. 10.1177/0269216319866641.