Sunday, October 23, 2011
Grand Ballroom AB (Hyatt Regency Chicago)
Poster Board # 48
(DEC) Decision Psychology and Shared Decision Making

Candidate for the Lee B. Lusted Student Prize Competition

Frederika E. Witkamp, RN1, L. van Zuylen, MD, PhD2, C.C.D. van der Rijt, MD, PhD, Prof2 and A. van der Heide, MD, PhD2, (1)Erasmus MC University Medical Center, Rotterdam, Netherlands, (2)Erasmus MC University Medical Centre, Rotterdam, Netherlands

Purpose: In the Netherlands one third of all deaths (n=35,000 per year) occurs in a hospital. There is growing interest in palliative care and adequate end-of-life decision making in hospitals. In clinical practice palliative care is mainly focused on the cancer patient, although dying trajectories of non-cancer patients are known to be less predictable. In this study we investigated similarities and differences in end-of-life decision making for cancer and non-cancer patients in the hospital.

Method: All general wards (17) and a specialised unit for acute palliative care in a Dutch university hospital participated in this study. For every patient older than 18 years who had died at one of the participating wards after having been admitted at least 6 hours prior to death, physicians were asked to complete a written questionnaire.

Result: Between June 2009 and February 2011, we received 226 questionnaires. The median age of the deceased patients was 67 years, 56% were male and 49% had cancer. The median length of the last hospitalization was 11 days. During the last month of life, physicians more often discussed end-of-life treatment options with cancer patients than with non-cancer patients (euthanasia: 22% vs 6%*; palliative sedation 41% vs 12%*; intensive symptom control 43% vs 17%*). DNR policy was also more often discussed with cancer patients: 51% vs 34%*.  Physicians were aware of the imminence of death in the large majority of all patients (89% and 83%); no differences between both groups were found in the moment of such awareness. However, physicians discussed imminent death with 67% of cancer patients and with 35% of non-cancer patients*.In the dying phase cancer patients were more often than non-cancer patients treated with opioids (89% vs 66%*) or continuous palliative sedation therapy (35% vs 19%*).

Conclusion: Physicians often recognize imminent death in cancer patients as well as in non-cancer patients. Nevertheless discussion of imminent death and end-of-life decision making is more common in cancer patients than in non-cancer patients. Shared decision making at the end of life could be further improved, especially for non-cancer patients. * Chi-square, p< 0.05