Living till the End: Cancer Patients in the Last Phase of Life

In this thesis, two main subjects are addressed: quality of life of cancer patients in their last phase of life (part 1 of the thesis) and end-of-life care and medical decision making (part 2 of the thesis). The first part of the thesis includes studies on the psychological status and feelings of cancer patients after they have been informed of their diagnosis of incurable cancer, and on the quality of life of these patients during their last year of life. The second part explores the content and evaluation of end- of-life care, and patients care needs. This part also addresses the attitudes of cancer patients toward medical end-of-life decision making and differences in dying at home or in an institution

Dying at home or in an institution: perspectives of Dutch physicians and bereaved relatives

Introduction Previous studies have shown that most people prefer to die at their own home. We investigated whether physicians or bereaved relatives in retrospect differently appreciate the dying of patients in an institution or at home. Materials and methods Of 128 patients with incurable cancer who were followed in the last phase of their lives, 103 passed away during follow-up. After death, physicians filled out a written questionnaire for 102 of these patients, and 63 bereaved relatives were personally interviewed. Results Of 103 patients, 49 died in an institution (mostly a hospital), and 54 died at home (or in two cases in a home-like situation). Patients who had been living with a partner relatively often died at home. Bereaved relatives knew of the patient’s wish to die at home in 25 out of 63 cases; 20 of these patients actually died at home. Thirty-one patients had no known preference concerning their place of dying. Most symptoms and the care provided to address them were equally prevalent in patients dying in an institution and patients dying at home. Bereaved relatives were in general quite satisfied about the provision of medical and nursing care in both settings. Conclusion We conclude that most patients’ preferences concerning the place of dying can be met. In about half of all cases, patients do not seem to have a clear preference concerning their place of dying, which is apparently not a major concern for many people. We found no indication that dying in an institution or at home involves major differences in the process and quality of dying