Prognostic Awareness,Will to Live and Health Care Expectation in Patients with Terminal Cancer / 中国医学伦理学

ABSTRACT

Objective:under the protective medical system,health care professional incline not to disclose the medical information to vulnerable patients in order to protect them from any unpleasant stimuli which might worsen their illness condition.This study aims to understand how patients' perceived illness severity and prognostic awareness impact on their will to live and healthcare expectations.Participants & Methods:twenty newly admitted patients,6 men and 14 women,with confirmed diagnosis of metastasis cancer in a hospice ward in Shanghai participated in the study.Semi-structured interviews were used to illicit the patients' view and experience.The interview questions include the patients' understanding of their illness condition,concerns in different aspects of life and expectation on treatment and care.Audio-recorded interviews were verbatim transcribed and analyzed using vanKaam's method of controlled explication.Result:although the patients did not learn their illness directly from others,they were able to capture their illness severity by observing the reaction of doctors or family members.Among them,9 patients actively sought evidence to confirm their illness condition.Although all 20 patients considered themselves gravely ill,their will to live ranged form very strong to very weak,which can be categorized into three major kinds of responses struggling for life,letting-it-to-happen and pleading for death.The patient's level of prognostic awareness did not have a strong association with their will to live,but the will to live was associated with their expressed quality of life concerns.The patients with more negative emotion,weaker family ties and more physical discomforts had weaker will to live.The patients who had unfinished business such as young children had the strongest will to live.The letting-it-go-happen patients were complacent that they had fulfilled their life responsibilities.Both patients who struggled for life and who pleaded for a hastened death had unrealistic healthcare expectations.The former hoped the medical staff could cure their illness whilst the latter preferred the medical staff to end their life.This is inconsistent to the concept of hospice care as dying should be treated as a natural process.Conclusion: This study shows that empathetic and open interactions with terminally cancer patients are possible.No untoward emotional reactions were noted after the interviews.The patients could receive better psychological support form the health care providers,and their needs were more realistically addressed.Furthermore,it can facilitate the family and healthcare providers to fulfill patients' last wishes and help them to pass their last days in peace,comfort and dignity.