Advance directives: cancer patients' preferences and family-based decision making

// Yan-Fang Xing 1, 2, 3, * , Jin-Xiang Lin 4, * , Xing Li 4, * , Qu Lin 4, * , Xiao-Kun Ma 4, * , Jie Chen 4 , Dong-Hao Wu 4 , Li Wei 4 , Liang-Hong Yin 1, 2 , Xiang-Yuan Wu 4 1 Department of Nephrology, First Affiliated Hospital of Jinan University, Guangzhou 510630, People’s Republic of China 2 School of Medicine, Jinan University, Guangzhou 510632, People’s Republic of China 3 Department of Nephrology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, People’s Republic of China 4 Department of Medical Oncology, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China * These authors contributed equally to this work Correspondence to: Liang-Hong Yin, email: 13725251458@126.com Xiang-Yuan Wu, email: wuxiangy@mail.sysu.edu.cn Keywords: advance directive, medical decision making, cancer, patients’ preference Received: February 08, 2017 Accepted: March 21, 2017 Published: April 28, 2017 ABSTRACT Background: Advance directives are a sensitive issue among traditional Chinese people, who usually refrain from mentioning this topic until it is imperative. Medical decisions for cancer patients are made by their families, and these decisions might violate patients’ personal will. Objectives: This study aimed to examine the acceptance of advance directives among Chinese cancer patients and their families and patient participation in this procedure and, finally, to analyze the moral risk involved. Results: While 246 patients and their family members refused official discussion of an advance directive, the remaining 166 patients and their families accepted the concept of an advance directive and signed a document agreeing to give up invasive treatment when the anti-cancer treatment was terminated. Of these, only 24 patients participated in the decision making. For 101 patients, anti-cancer therapy was ended prematurely with as many as 37 patients not told about their potential loss of health interests. Materials and Methods: Participants were 412 adult cancer patients from 9 leading hospitals across China. An advance directive was introduced to the main decision makers for each patient; if they wished to sign it, the advance directive would be systematically discussed. A questionnaire was given to the oncologists in charge of each patient to evaluate the interaction between families and patients, patients’ awareness of their disease, and participation in an advance directive. Conclusions: Advance directives were not widely accepted among Chinese cancer patients unless anti-cancer therapy was terminated. Most cancer patients were excluded from the discussion of an advance directive.