Laryionava Katsiaryna, Winkler Eva Caroline
Department of Medical Oncology, National Center for Tumor Diseases (NCT), Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
Institute for History and Ethics of Medicine, Centre for Health Sciences, Martin Luther University Halle-Wittenberg (Saale), Halle (Saale), Germany.
Curr Oncol Rep. 2021 Aug 27;23(11):124. doi: 10.1007/s11912-021-01122-x.
The family plays a significant role in end-of-life care and decision-making with advanced cancer patients. This non-systematic review aims to summarize the family role and possible emerging conflicts and problems related to family involvement in decisions with advanced cancer patients.
Four important domains were identified: (1) discordance between patients and caregivers' understanding of prognosis and goals of care; (2) internal family conflicts; (3) cultural differences regarding the role of the family in end-of life decision-making; (4) the burden on caregivers through caring for cancer patients. Based on the findings, we formulated some implications to consider for clinical practice. We suggest to involve the family in decision-making, to ascertain patients' wish for family involvement and if necessary, taking a mediator role between patients and their caregivers; to be aware of "invisible" family influence on patients' decisions; to assess systematically family burden and needs; to provide timely information, psychological support interventions and palliative care.
家庭在晚期癌症患者的临终关怀和决策中起着重要作用。本非系统性综述旨在总结家庭角色以及与家庭参与晚期癌症患者决策相关的可能出现的冲突和问题。
确定了四个重要领域：（1）患者与照料者对预后和护理目标的理解不一致；（2）家庭内部冲突；（3）家庭在临终决策中角色的文化差异；（4）照料癌症患者给照料者带来的负担。基于这些发现，我们提出了一些临床实践中需考虑的建议。我们建议让家庭参与决策，确定患者对家庭参与的意愿，必要时在患者及其照料者之间充当调解人；意识到家庭对患者决策的“无形”影响；系统评估家庭负担和需求；提供及时的信息、心理支持干预和姑息治疗。
