490P - Decisions made by surrogates for patients versus oneself in an irreversible coma: A study to determine the importance of advance directives in the...

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Bioethics, Legal, and Economic Issues
Palliative Care
Presenter Keshinie Samarasekara
Citation Annals of Oncology (2016) 27 (suppl_9): ix157-ix160. 10.1093/annonc/mdw595
Authors K. Samarasekara
  • Neurosurgery, The National Hospital of Sri Lanka, 01000 - Colombo/LK

Abstract

Background

Advance directives are the documents a person completes while still in possession of decisional capacity about how treatment decisions should be made on her or his behalf in the event she or he loses the capacity to make such decisions. They are legal tools to guide treatment decision-making.

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Studies have shown that even though people had given thought to the question of end-of-life care, a majority had not completed the advance directive forms, even in countries where an organized system is available to provide advance directives. In the Sri Lankan health-care system there is no formal method for documentation of advance directives. Therefore the treatment decisions are made by the attending consultant with consideration to the wishes of the relatives.

Methods

This study was done on immediate next-of-kin of 120 permanently unconscious patients, including 16 patients with brain tumours or brain metastasis from other tumors, admitted to the neurosurgery department of a tertiary care hospital in Sri Lanka. It compared the decisions made by surrogates for the patients with the decisions they would make for oneself given the hypothetical situation of a similar condition. The data were gathered using one-to-one interviews with the surrogates.

Results

More than ninety-percent of surrogates wanted their patient to be given CPR (cardiopulmonary resuscitation) [including defibrillation] in the event of cardiopulmonary arrest. However, when questioned regarding the hypothetical situation where themselves are in a similar condition, majority of them refused to be given CPR.

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Likewise, more than seventy-five-percent wanted their patient to be provided nutrition via a tube, whereas they didn’t want that done to themselves if they were in a similar situation. Even though majority opted to continue life sustaining treatment for their patient, they didn’t want such for themselves if they were hypothetically in a similar condition.

Conclusions

The findings of this study highlights the importance of implementing an effective system for documentation of advance directives and encouraging patients to make use of it, as the decisions made by surrogates for patients vary greatly from the decisions they would make for themselves.

Clinical trial indentification

Legal entity responsible for the study

K. R. Samarasekara

Funding

K. R. Samarasekara

Disclosure

All authors have declared no conflicts of interest.