The Relationship among Attitudes toward the Withdrawal of Life-sustaining Treatment, Death Anxiety, and Death Acceptance among Hospitalized Elderly Cancer Patients

PURPOSE: The purpose of this study was to identify the relationship between attitudes toward the withdrawal of life-sustaining treatment, death anxiety and death acceptance among hospitalized cancer patients who were at least 65 years old. METHODS: This study adopted a descriptive study design. Data were collected from 128 patients diagnosed with cancer. The instruments used were the Attitudes toward Life-sustaining Treatment Scale, Death Anxiety Scale and modified versions of the Death Attitude Profile-Revised (DAP-R) questionnaire. RESULTS: The mean score for the subjects' attitudes toward the withdrawal of life-sustaining treatment was 3.48±0.50 out of 5. Death anxiety was reported at 2.53±0.54 out of 4. Death acceptance was reported at 4.10±1.20 out of 7. There was a significant negative correlation between the subjects' attitudes toward the withdrawal of life-sustaining treatment and death anxiety (r=−.21, p=.018), however there was no statistically significant correlation between the subjects' attitude towards the withdrawal of life-sustaining treatment and death acceptance (r=−.07, p=.462) CONCLUSION: The more positive elderly cancer patients are about the withdrawal of life-sustaining treatment, the lower their death anxiety is. This finding can help nurses with patient care towards the end of life by considering the relationship between death anxiety and their attitudes toward the withdrawal of life-sustaining treatment.

Reflections on end-of-life dialysis / Reflexões sobre a diálise no fim da vida

ABSTRACT The world population is aging and diseases such as diabetes mellitus and systemic arterial hypertension are increasing the risk of patients developing chronic kidney disease, leading to an increase in the prevalence of patients on dialysis. The expansion of health services has made it possible to offer dialysis treatment to an increasing number of patients. At the same time, dialysis survival has increased considerably in the last two decades. Thus, patients on dialysis are becoming more numerous, older and with greater number of comorbidities. Although dialysis maintains hydroelectrolytic and metabolic balance, in several patients this is not associated with an improvement in quality of life. Therefore, despite the high social and financial cost of dialysis, patient recovery may be only partial. In these conditions, it is necessary to evaluate the patient individually in relation to the dialysis treatment. This implies reflections on initiating, maintaining or discontinuing treatment. The multidisciplinary team involved in the care of these patients should be familiar with these aspects in order to approach the patient and his/her relatives in an ethical and humanitarian way. In this study, we discuss dialysis in the final phase of life and present a systematic way to address this dilemma.

RESUMO A população mundial está envelhecendo, e doenças como diabetes mellitus e hipertensão arterial sistêmica estão aumentando o risco de doença renal crônica, com consequente elevação na prevalência de pacientes em diálise. A expansão dos serviços de saúde permitiu oferecer tratamento dialítico para um número cada vez maior de pacientes. Paralelamente, a sobrevida em diálise aumentou consideravelmente nas últimas duas décadas. Dessa maneira, os pacientes em diálise são cada vez mais numerosos, mais idosos e com maior número de comorbidades. Embora a diálise mantenha o equilíbrio hidroeletrolítico e metabólico, em diversos pacientes isso não está associado à melhora da qualidade de vida. Então, apesar do elevado custo social e financeiro da diálise, a recuperação do paciente pode ser apenas parcial. Nessas condições, é necessário avaliar individualmente o paciente em relação ao tratamento dialítico, o que implica reflexões sobre iniciar, manter ou suspender o tratamento. A equipe multidisciplinar envolvida no cuidado desses pacientes deve estar familiarizada com esses aspectos para abordar o paciente e seus familiares de forma ética e humanitária. Neste estudo, foi discutido o tratamento dialítico na fase final da vida e apresentada uma maneira sistemática para enfrentar esse dilema.