Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study
Abstract Background Communication in do not resuscitate (DNR) and artificial nutrition and hydration (ANH) at the end of life is a key component of advance care planning (ACP) which is essential for patients with advanced cancer to have cares concordant with their wishes. The SOP model (Shared decis...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12904-020-0521-7 |
| _version_ | 1818676445176659968 |
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| author | Hsien-Liang Huang Jaw-Shiun Tsai Chien-An Yao Shao-Yi Cheng Wen-Yu Hu Tai-Yuan Chiu |
| author_facet | Hsien-Liang Huang Jaw-Shiun Tsai Chien-An Yao Shao-Yi Cheng Wen-Yu Hu Tai-Yuan Chiu |
| author_sort | Hsien-Liang Huang |
| collection | DOAJ |
| description | Abstract Background Communication in do not resuscitate (DNR) and artificial nutrition and hydration (ANH) at the end of life is a key component of advance care planning (ACP) which is essential for patients with advanced cancer to have cares concordant with their wishes. The SOP model (Shared decision making with Oncologists and Palliative care specialists) aimed to increase the rate of documentation on the preferences for DNR and ANH in patients with advanced cancer. Methods The SOP model was implemented in a national cancer treatment center in Taiwan from September 2016 to August 2018 for patients with advanced cancer visiting the oncology outpatient clinic. The framework was based on the model of shared decision making as “choice talk” initiated by oncologists with “option talk” and “decision talk” conducted by palliative care specialists. Results Among 375 eligible patients, 255 patients (68%) participated in the model testing with the mean age of 68.5 ± 14.7 years (mean ± SD). Comparing to 52.3% of DNR documentation among patients with advanced cancer who died in our hospital, the rate increased to 80.9% (206/255) after the decision talk in our model. Only 6.67% (n = 17) of the participants documented their preferences on ANH after the model. A worse Eastern Cooperative Oncology Group Performance Status was the only statistically significant associating factor with a higher rate of DNR documentation in the multiple logistic regression model. Conclusions The SOP model significantly increased the rate of DNR documentation in patients with advanced cancer in this pilot study. Dissemination of the model could help the patients to receive care that is concordant with their wishes and be useful for the countries having laws on ACP. |
| first_indexed | 2024-12-17T08:43:35Z |
| format | Article |
| id | doaj.art-ddd8b8acff874853a91a5bd10bdefca1 |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-12-17T08:43:35Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-ddd8b8acff874853a91a5bd10bdefca12022-12-21T21:56:16ZengBMCBMC Palliative Care1472-684X2020-02-011911910.1186/s12904-020-0521-7Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing studyHsien-Liang Huang0Jaw-Shiun Tsai1Chien-An Yao2Shao-Yi Cheng3Wen-Yu Hu4Tai-Yuan Chiu5Department of Family Medicine, College of Medicine and HospitalDepartment of Family Medicine, College of Medicine and HospitalDepartment of Family Medicine, College of Medicine and HospitalDepartment of Family Medicine, College of Medicine and HospitalSchool of Nursing, College of Medicine and Hospital, National Taiwan UniversityDepartment of Family Medicine, College of Medicine and HospitalAbstract Background Communication in do not resuscitate (DNR) and artificial nutrition and hydration (ANH) at the end of life is a key component of advance care planning (ACP) which is essential for patients with advanced cancer to have cares concordant with their wishes. The SOP model (Shared decision making with Oncologists and Palliative care specialists) aimed to increase the rate of documentation on the preferences for DNR and ANH in patients with advanced cancer. Methods The SOP model was implemented in a national cancer treatment center in Taiwan from September 2016 to August 2018 for patients with advanced cancer visiting the oncology outpatient clinic. The framework was based on the model of shared decision making as “choice talk” initiated by oncologists with “option talk” and “decision talk” conducted by palliative care specialists. Results Among 375 eligible patients, 255 patients (68%) participated in the model testing with the mean age of 68.5 ± 14.7 years (mean ± SD). Comparing to 52.3% of DNR documentation among patients with advanced cancer who died in our hospital, the rate increased to 80.9% (206/255) after the decision talk in our model. Only 6.67% (n = 17) of the participants documented their preferences on ANH after the model. A worse Eastern Cooperative Oncology Group Performance Status was the only statistically significant associating factor with a higher rate of DNR documentation in the multiple logistic regression model. Conclusions The SOP model significantly increased the rate of DNR documentation in patients with advanced cancer in this pilot study. Dissemination of the model could help the patients to receive care that is concordant with their wishes and be useful for the countries having laws on ACP.https://doi.org/10.1186/s12904-020-0521-7Shared decision makingAdvanced care planningAdvanced cancerDo not resuscitateArtificial nutrition and hydration |
| spellingShingle | Hsien-Liang Huang Jaw-Shiun Tsai Chien-An Yao Shao-Yi Cheng Wen-Yu Hu Tai-Yuan Chiu Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study BMC Palliative Care Shared decision making Advanced care planning Advanced cancer Do not resuscitate Artificial nutrition and hydration |
| title | Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study |
| title_full | Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study |
| title_fullStr | Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study |
| title_full_unstemmed | Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study |
| title_short | Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study |
| title_sort | shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer a model testing study |
| topic | Shared decision making Advanced care planning Advanced cancer Do not resuscitate Artificial nutrition and hydration |
| url | https://doi.org/10.1186/s12904-020-0521-7 |
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