Perception of a "good death" in Thai patients with cancer and their relatives

Jarin Chindaprasirt; Nattapat Wongtirawit; Panita Limpawattana; Varalak Srinonprasert; Manchumad Manjavong; Verajit Chotmongkol; Srivieng Pairojkul; Kittisak Sawanyawisuth

doi:10.1016/j.heliyon.2019.e02067

Perception of a "good death" in Thai patients with cancer and their relatives

Heliyon. 2019 Jul 12;5(7):e02067. doi: 10.1016/j.heliyon.2019.e02067. eCollection 2019 Jul.

Authors

Jarin Chindaprasirt¹, Nattapat Wongtirawit², Panita Limpawattana³, Varalak Srinonprasert⁴, Manchumad Manjavong³, Verajit Chotmongkol⁵, Srivieng Pairojkul⁶, Kittisak Sawanyawisuth⁷

Affiliations

¹ Division of Oncology Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
² Residency Training in Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
³ Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
⁴ Division of Geriatric Medicine, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Thailand.
⁵ Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
⁶ Palliative Care Unit, Faculty of Medicine, Khon Kaen University, Thailand.
⁷ Division of Ambulatory Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.

Abstract

Background: Understanding the perceptions regarding what constitutes a "good death" among cancer patients and their families could help healthcare teams to ensure proper palliative and supportive care.

Objectives: To demonstrate and compare the wishes cancer patients and the perceptions of their relatives regarding end-of-life care, and to identify factors associated with patients' preferences regarding place of death.

Methods: A sample of cancer patients and their relatives who attended the Srinagarind Hospital (Thailand) oncology clinic or day chemotherapy from September 2017 to August 2018 were enrolled. Questionnaires were given to the participants, in which the patients were asked to respond based on their own end-of-life preferences, and relatives were asked to imagine how the patients would respond to the questions.

Results: One hundred eighty pairs of patients and relatives were recruited. Respondents in both groups placed importance on place of death, relationship with family, physical and psychological comfort, and relationship with the medical staff. Both groups generally agreed with the statements on the questionnaire (10/13 statements). Relatives underestimated the preferences of the patients in 3 areas: "not being a burden to others," "preparation for death," and "physical and psychological comfort." Being married (adjusted odds ratio (AOD) 6.4, 95%confidence interval (CI) 1.1,36.5), having had more than 6 years of education (AOD 6.5, 95%CI 1.8,23.7), having lung cancer compared to colon cancer (AOD 12, 95%CI 1.2,118.7), duration after cancer diagnosis (AOD 0.9, 95%CI 0.93,0.99), previous hospital admission (AOD 5.7, 95%CI 1.5,21.2), and life satisfaction (AOD 17.6, 95%CI 2.9,104.9) were factors associated with preference for home death.

Conclusion: Thai cancer patients and their relatives indicated similar preferences with regard to what constitutes a good death and patients' wishes for their end-of-life period. However, the patients' relatives underestimated the importance patients placed on statements in three domains. Factors that influenced a preference for a home death were identified.

Keywords: Advance care planning; End-of-life care; Good death; Home death; Palliative care; Psychology.