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Open AccessArticle

Preferences on the Timing of Initiating Advance Care Planning and Withdrawing Life-Sustaining Treatment between Terminally-Ill Cancer Patients and Their Main Family Caregivers: A Prospective Study

1
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London SE5 9PJ, UK
2
Institute of Community Health Care, School of Nursing, National Yang-Ming University, Taipei 112304, Taiwan
3
Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei 100229, Taiwan
4
Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
5
Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London W1T 7NF, UK
6
Department of Family Medicine, Taipei City Hospital, Taipei 10341, Taiwan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(21), 7954; https://doi.org/10.3390/ijerph17217954
Received: 21 September 2020 / Revised: 27 October 2020 / Accepted: 28 October 2020 / Published: 29 October 2020
(This article belongs to the Section Health Care Sciences & Services)
Background: The Western individualistic understanding of autonomy for advance care planning is considered not to reflect the Asian family-centered approach in medical decision-making. The study aim is to compare preferences on timing for advance care planning initiatives and life-sustaining treatment withdrawal between terminally-ill cancer patients and their family caregivers in Taiwan. Methods: A prospective study using questionnaire survey was conducted with both terminally-ill cancer patient and their family caregiver dyads independently in inpatient and outpatient palliative care settings in a tertiary hospital in Northern Taiwan. Self-reported questionnaire using clinical scenario of incurable lung cancer was employed. Descriptive analysis was used for data analysis. Results: Fifty-four patients and family dyads were recruited from 1 August 2019 to 15 January 2020. Nearly 80% of patients and caregivers agreed that advance care planning should be conducted when the patient was at a non-frail stage of disease. Patients’ frail stage of disease was considered the indicator for life-sustaining treatments withdrawal except for nutrition and fluid supplements, antibiotics or blood transfusions. Patient dyads considered that advance care planning discussions were meaningful without arousing emotional distress. Conclusion: Patient dyads’ preferences on the timing of initiating advance care planning and life-sustaining treatments withdrawal were found to be consistent. Taiwanese people’s medical decision-making is heavily influenced by cultural characteristics including relational autonomy and filial piety. The findings could inform the clinical practice and policy in the wider Asia–Pacific region. View Full-Text
Keywords: advance care planning; life-sustaining treatment; medical decision-making; relational autonomy; terminal cancer advance care planning; life-sustaining treatment; medical decision-making; relational autonomy; terminal cancer
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MDPI and ACS Style

Lin, C.-P.; Peng, J.-K.; Chen, P.-J.; Huang, H.-L.; Hsu, S.-H.; Cheng, S.-Y. Preferences on the Timing of Initiating Advance Care Planning and Withdrawing Life-Sustaining Treatment between Terminally-Ill Cancer Patients and Their Main Family Caregivers: A Prospective Study. Int. J. Environ. Res. Public Health 2020, 17, 7954.

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