Factors influencing views of patients with gynecologic cancer about end-of-life decisions,☆☆,,★★

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Abstract

OBJECTIVE: This study was undertaken to assess the life views, practices, values, and aspirations of women with various stages of gynecologic cancer. STUDY DESIGN: A self-administered questionnaire was completed by 108 women with various stages of cancer and 39 women with benign gynecologic disease. The questionnaire included items on demographics in addition to 16 multiple choice and 4 true-false items. The four questions related to criteria of good care, degree of involvement in decision making, psychosocial well-being, religious experience, and aspirations form the basis of this study. The data were analyzed with the Pearson χ2 test (Systat, version 5.1) with significance set at p < 0.05. RESULTS: The women in this study placed greatest emphasis on receiving “straight talk” (96%) and compassion (64%) from their physicians. The newly diagnosed group put significantly less emphasis on compassion (33%, p = 0.037). Less than half expected their physicians to cure (43%, 56% for newly diagnosed) or contain (49%) the disease. For these women fear was the most dominant psychosocial consequence of having cancer, with difficulty communicating or feeling abandoned, isolated, or embarrassed less common. Those who specified their fears were afraid of pain (63% vs 39% for patients with benign disease, p = 0.019), dying (56%), losing control (48%), or becoming totally dependent (46%). Seventy-six percent indicated that religion had a serious place in their lives, with 49% becoming more religious since their cancer diagnosis, whereas no one became less religious. Ninety-three percent believed that the religious commitment helped sustain their hopes. CONCLUSIONS: These data suggest that (1) physicians should aim to educate their patients sufficiently for them to exercise control over their experience, to allay their fears, and to make personal decisions that further their aspirations, (2) patients in different stages of disease varied in their perceptions of themselves and their aspirations, (3) patients are dealing with fear as a primary problem, and (4) women with gynecologic cancer depend on their religious convictions and experiences as they cope with the disease. (Am J Obstet Gynecol 1997;176:166-72.)

Section snippets

Subjects and methods

Respondents for this study came from the patients seen by the Oncology Service of the Department of Obstetrics and Gynecology at the University of Michigan Medical Center (Ann Arbor, Mich.). The members of a benign disease group came from the department's gynecology service. After Institutional Review Board approval was obtained, data were collected between August 1989 and May 1991. All participating patients gave informed consent.

A self-administered questionnaire was developed for this study.

Results

Table I presents selected demographic and medical data concerning the study sample.A total of 108 patients with gynecologic cancer agreed to participate. A total of 39 cancer-free women constituted the benign disease group. The cancer group and the benign disease group had similar profiles, except that the cancer group was older (54 years vs 45 years) and had more experience with life-threatening disorders other than cancer. There were other small differences between these two groups, but they

Comment

We realize that studies dependent on data collected through use of a personal response questionnaire can be biased by the selection and wording of the questions. Nor can self-reported data, reflecting a respondent's perceptions at the time of participation, predict changes in patient disposition as the disease process continues. More important, data collection by use of a questionnaire is limited by the level of patient involvement. In this study, 50% of the women asked to complete the

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  • Cited by (0)

    From the Departments of Obstetrics and Gynecology, University of Michigana and Louisiana State University,b and the Department of Psychiatry, Duke University Medical Center.c

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    Supported by Monarch, a Division of King Pharmaceuticals, Bristol, Tennessee.

    Reprint requests: James A. Roberts, MD, University of Michigan Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0718.

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