The American Cancer Society makes a shocking estimate that close to 606,520 Americans are likely to have died of cancer in 2020. Anticipation of the end of life (EOL) and taking necessary or preferred health care decisions while nearing this period is mentally and emotionally distressing for patients with advanced cancer and everyone around them. These people include their families and friends, doctors, and other caregivers. But, the adverse repercussions of failing to plan for the shift to EOL care are usually greater psychological distress, inconsistent medical treatments, use of burdensome and costly health care aids that are of little benefit, and/or a tough bereavement.
Determining the quality of EOL care
EOL planning provides cancer patients with the necessary tools to make proper health care and financial decisions during a period when they are physically and mentally capable of making decisions. The four main components of EOL planning for cancer patients include:
1) Drafting a living will or an advance directive (AD),
2) Granting a person a power of attorney for their health care,
3) Writing a document specifying the terms for distribution of assets and wealth, and
4) Expressing preferences for the type and location of care.
Patients and oncologists often tend to avoid or postpone EOL planning until the final days or weeks of life. This may be owing to the many potential reasons at the individual, familial, or societal levels. However, emerging evidence suggests that people can overcome many of these factors.
The patient suffering from advanced cancer, along with their family and friends, and the oncologist often encounter treatment decisions that significantly affect the patient’s quality of life (QOL). The quality of EOL care in patients with advanced cancer can be determined by asking the following questions:
- Which guidelines evidence the assessment of QOL?
- What time period specifies the EOL?
- How accurate, readily available, and plausible are the indicators of QOL?
- Are these indicators linked to desired results?
- What constitutes high EOL?
- Is the patient’s preference given precedence?
If these EOL factors are properly considered, an increasing number of advanced cancer patients may go for a new chemotherapy session a month before their death or continue with it at least till two weeks before death. Also, an increasing number of advanced cancer patients go for hospice care, which really is a healthy alternative.
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