1433P - Factors associated with surrogate decision-making in advanced cancer patients: a longitudinal study

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Palliative Care
Presenter Dae Heo
Authors D. Heo, J.K. Lee, A. An, B. Keam, T. Kim, S. Lee, D. Kim
  • Internal Medicine, Seoul National University Hospital, 110-744 - Seoul/KR

Abstract

Purpose

Although surrogate decision-making in cancer patients is well-known, few studies investigating the prevalence of surrogate decision-making over time have been reported. The objectives of this study were to investigate the level of surrogate decision-making in advanced cancer patients over time and the impact of demographic and clinical variables on surrogate decision-making.

Methods

The level of surrogate decision-making was measured in 572 consecutive cancer patients who died between January 1 and December 31, 2009. We reviewed 8,639 informed consent forms of these patients, calculated the proportion of decisions made by a surrogate (PDS) for each patient, and analyzed the association of PDS with demographic and clinical variables.

Results

Surrogates completed 40.3% of all consent forms. The prevalence of surrogate decision-making was higher in the end-of-life period (death <7 days: OR = 29.05, reference: >365 days). Surrogates signed consent forms more frequently for do-not-resuscitate directives, intensive care unit admission, emergency hemodialysis, surgery and invasive interventions compared with chemotherapy, radiotherapy, and diagnostic tests (OR = 3.88, P < 0.001). Patients of older age (P = 0.036) and those with a shorter duration of management (P < 0.001) were independently associated with greater PDS.

Conclusions

Surrogate decision-making was frequently observed among Korean cancer patients in this study, especially when the patient's death was imminent, and for decisions related to end-of-life care. Surrogates were also frequently involved in decisions for elderly or rapidly deteriorating patients. Healthcare professionals should consider the significant role of familial surrogates in the end-of-life period; comprehensive approaches are needed to preserve the best interest of the patients.

Disclosure

All authors have declared no conflicts of interest.