Ethnicity influences family involvement in end-of-life decisions

By Sarah Guy, medwireNews Reporter

Research in Singapore reveals that, as cancer patients age, their families play a larger role in their healthcare decision-making, with patients themselves becoming less involved as their condition deteriorates.

The study highlights how Asian and Western approaches to patient involvement in decision-making differ, the authors say.

Their study showed that patients and families were involved in the disclosure of diagnosis and initial treatment decisions in over 60% of cases in the study, while just 9% of alert patients were consulted in end-of-life decisions, report the researchers.

"The healthcare decision making process in Asian societies, including Singapore, tends to prioritise the family above the individual, whereas the competent patient is the healthcare decision maker in western developed nations," say Grace Meijuan Yang (National Cancer Centre Singapore) and colleagues.

"Relatives may believe they are making decisions based on a patient's best interests... However, it is difficult to see how a decision can be made... when the patient has been excluded from the process," adds the team in BMJ Supportive and Palliative Care.

Using medical records for 55 patients who died on an oncology ward between February and April 2011, the authors observed that 51 patients were "alert" at the time of diagnosis, while the remaining four patients were drowsy or unresponsive.

Despite this, 17 (39%) patients were excluded from the discussion about diagnosis and even after a month, six patients remained unaware of their condition.

Of the 44 patients involved in the initial treatment decision-making discussion, 23 changed their approach from curative to non-curative, and for five of these patients, the family alone decided on this change.

Advanced patient age (65 years or older) and an inability to speak English were both significantly associated with inclusion of the family at the first diagnosis disclosure, with increased odds of 14.8 and 9.1, respectively.

These same factors, as well as having a non-curative treatment strategy, also significantly increased the odds for involvement of the family in deciding the initial treatment approach, report Meijuan Yang et al.

"The family members' desire to 'protect' and support the patient may explain why families were commonly involved in the first disclosure of the diagnosis and during decision making for the initial treatment," they note.

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