Patients with advanced cancer value ‘realistic care’ goals that avoid costly treatments
Click Here to Manage Email Alerts
Key takeaways:
- Patients and caregivers prioritized symptom management over life extension.
- Goals of care did not change as patients neared death.
More than one-third of patients and one-fourth of patient caregivers favor focusing on symptom management of advanced cancers over life extension, according to study findings published in JAMA Network Open.
The results also showed little difference in attitudes about the goals of care between patients and caregivers as those with cancer neared death.
“This cohort study found that when patients and caregivers were asked to make tradeoffs, a common goal of care among dyads was a moderate approach of balancing life extension against symptom management or cost containment,” Semra Ozdemir, PhD, associate professor of population health sciences at Duke University School of Medicine, and colleagues wrote.
“However, patients exhibited a stronger preference toward cost containment compared with their caregivers,” they added. “These findings emphasize the need for interventions that reduce discordance in goals of care between patients and caregivers, helping them develop realistic care expectations and avoid costly, futile treatments.”
Background, methods
Researchers conducted a prospective cohort study to investigate and understand any patterns that emerged from goals of care among patient-caregiver dyads during the final 2 years of a patient’s life.
The study included 210 patient-caregiver dyads, performed via surveys once every 3 months from July 8, 2016, until either the patient’s death or Feb. 28, 2022.
Dyads included patients with stage IV solid cancer and their caregivers, which researchers recruited from outpatient clinics at two major cancer centers in Singapore.
Examining the goals of care via tradeoffs between life extension and symptom management, as well as between life extension and cost containment, served as the study’s main outcome measurement.
Results, next steps
Among the 210 dyads (patients: mean age, 62.6 years, 51.4% men; caregivers: mean age, 49.4 years, 62.9% women), 34% of patients and 29% of caregivers prioritized symptom management over life extension, compared with 24% of patients and 19% of caregivers who prioritized life extension.
Between the choice of either cost containment or life extension, 28% of patients and 17% of caregivers favored prioritizing cost containment, whereas 26% of patients and 35% of caregivers favored prioritizing life extension.
Researchers reported that goals of care did not change as patients neared death. Patients appeared to prioritize symptom management if they experienced higher symptom burden, worse spiritual well-being and accurate prognostic awareness, and if their caregivers reported accurate prognostic awareness, lower impact of caregiving on finances and poorer caregiving self-esteem.
Compared with their patient counterparts, caregivers expressed lower preferences for cost containment.
Patients prioritized cost containment if they were older and had higher symptom burden and poorer spiritual well-being, whereas their caregivers reported poorer caregiving self-esteem and more family support.
Study limitations included the general applicability of results to a wider population because the study cohort comprised only patients from Singapore with advanced cancer and their caregivers. Researchers also noted a potential for bias because the associations observed in the results came from self-reported behaviors.
The study findings highlight the importance of interventions specifically aimed at reducing discordance in goals of care to create realistic expectations that avoid costly or ineffective treatments.
“The findings on participant characteristics have implications for tailoring end-of-life care to individual preferences,” Ozdemir and colleagues wrote.
“Health care professionals could prioritize comprehensive symptom management strategies over potentially life-extending treatments, particularly for patients with higher symptom burden and poor spiritual well-being,” they added. “Ensuring accurate prognostic awareness among both patients and caregivers is pivotal to avoiding aggressive treatments."
Collapse
Read more about
Click Here to Manage Email Alerts