Let us talk about death: gender effects in cancer patients’ preferences for end-of-life discussions
Open Access
- 18 January 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Supportive Care in Cancer
- Vol. 28 (10), 4667-4675
- https://doi.org/10.1007/s00520-019-05275-1
Abstract
Purpose Patients with advanced cancer often receive suboptimal end-of-life (EOL) care. Particularly males with advanced cancer are more likely to receive EOL care that is more aggressive, even if death is imminent. Critical factors determining EOL care are EOL conversations or advance care planning. However, information about gender-related factors influencing EOL conversations is lacking. Therefore, the current study investigates gender differences concerning the content, the desired time point, and the mode of initiation of EOL conversations in cancer patients. Methods In a cross-sectional study, 186 female and male cancer patients were asked about their preferences for EOL discussions using a semi-structured interview, focusing on (a) the importance of six different topics (medical and nursing care, organizational, emotional, social, and spiritual/religious aspects), (b) the desired time point, and (c) the mode of discussion initiation. Results The importance of EOL topics differs significantly regarding issue (p = 0.002, η2 = 0.02) and gender (p < 0.001, η2 = 0.11). Males wish to avoid the engagement in discussions about death and dying particularly if they are anxious about their end-of-life period. They wish to be addressed regarding the “hard facts” nursing and medical care only. In contrast, females prefer to speak more about “soft facts” and to be addressed about each EOL topic. Independent of gender, the majority of patients prefer to talk rather late: when the disease is getting worse (58%), at the end of their therapy, or when loosing self-sufficiency (27.5%). Conclusion The tendency of patients to talk late about EOL issues increases the risk of delayed or missed EOL conversations, which may be due to a knowledge gap regarding the possibility of disease-associated incapability. Furthermore, there are significant gender differences influencing the access to EOL conversations. Therefore, for daily clinical routine, we suggest an early two-step, gender-sensitive approach to end-of-life conversations.Funding Information
- Philipps-Universität Marburg
This publication has 43 references indexed in Scilit:
- Gender differences in the evolution of illness understanding among patients with advanced cancerThe Journal of Supportive Oncology, 2013
- Patients' Expectations about Effects of Chemotherapy for Advanced CancerThe New England Journal of Medicine, 2012
- Place of Death: Correlations With Quality of Life of Patients With Cancer and Predictors of Bereaved Caregivers' Mental HealthJournal of Clinical Oncology, 2010
- End-of-Life Discussions, Goal Attainment, and Distress at the End of Life: Predictors and Outcomes of Receipt of Care Consistent With PreferencesJournal of Clinical Oncology, 2010
- Communication in End-Stage Cancer: Review of the Literature and Future ResearchJournal of Health Communication, 2009
- Health Care Costs in the Last Week of LifeArchives of Internal Medicine, 2009
- Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement AdjustmentJAMA, 2008
- Information giving and decision-making in patients with advanced cancer: A systematic reviewSocial Science & Medicine (1982), 2005
- Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study Commentary: Why do doctors overestimate? Commentary: Prognoses should be based on proved indices not intuitionBMJ, 2000
- Cancer patients' insight into their treatment, prognosis, and unconventional therapiesCancer, 1984