Decision-making in the End-Of-Life Phase of High-Grade Glioma Patients

Eur J Cancer. 2012 Jan;48(2):226-32. doi: 10.1016/j.ejca.2011.11.010. Epub 2011 Dec 5.

Abstract

Background: During the disease course of high-grade glioma (HGG) patients, the goal of therapy eventually shifts from primarily life-prolongation to primarily sustaining the quality of life as good as possible. End-of-life care is aimed at prolongation of life with good quality, but inevitably also may require medical decisions for prevention and relief of suffering with a potential life shortening effect. Few data are available on this end-of-life decision (ELD) making process in HGG patients, with decreased consciousness, confusion or cognitive deficits preventing them to participate. In this study the ELD-making process in HGG patients is described.

Methods: Physicians and relatives of a cohort of 155 deceased HGG patients were identified to fill in a questionnaire regarding the end-of-life conditions (patients' ELD preferences, patients' competence) and ELD-making (forgoing treatment and the administration of drugs with a potential life-shortening effect) for their patient or relative. Data were analysed with descriptive statistics.

Findings: Of 101 patients, physicians completed surveys including questions about ELDs (62% response rate). More than half of the patients relatively early became incompetent to make decisions due to delirium, cognitive deficits and/or decreasing consciousness. In 40% of patients the physician did not discuss ELD preferences with his/her patient. At least one ELD was made in 72% of patients, most often this comprised the withdrawal of dexamethasone. Palliative sedation was performed in 30% of patients and physician assisted death in 7%.

Interpretation: ELDs are common practises amongst HGG patients, although their preferences towards ELDs are frequently unknown to the physician. Because the majority of patients become incompetent towards death, participation in ELD-making is only possible with advanced care planning. Hence, timely discussion of ELD preferences is encouraged.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Brain Neoplasms / psychology
  • Brain Neoplasms / therapy*
  • Cohort Studies
  • Communication
  • Decision Making*
  • Family / psychology
  • Female
  • Glioma / psychology
  • Glioma / therapy*
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Physician-Patient Relations
  • Practice Patterns, Physicians' / statistics & numerical data
  • Retrospective Studies
  • Surveys and Questionnaires
  • Terminal Care* / psychology