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Influence of advance directives on reducing aggressive measures during end-of-life cancer care: A systematic review

Published online by Cambridge University Press:  28 August 2020

Lillian Ponchio e Silva Marchi ,
Martins Fideles dos Santos Neto ,
Júlia de Pauli Moraes ,
Carlos Eduardo Paiva Open the ORCID record for Carlos Eduardo Paiva [Opens in a new window]  and
Bianca Sakamoto Ribeiro Paiva Open the ORCID record for Bianca Sakamoto Ribeiro Paiva [Opens in a new window]
Lillian Ponchio e Silva Marchi
Affiliation:
Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
Martins Fideles dos Santos Neto
Affiliation:
Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
Júlia de Pauli Moraes
Affiliation:
Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
Carlos Eduardo Paiva*
Affiliation:
Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil Department of Clinical Oncology, Breast and Gynecology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
Bianca Sakamoto Ribeiro Paiva*
Affiliation:
Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
*
Author for correspondence: Bianca Sakamoto Ribeiro Paiva, Programa de Pós-Graduação em Oncologia, Rua Antenor Duarte Vilella, 1331, Bairro Dr. Paulo Prata, Barretos, São Paulo, Brazil, CEP: 14784-400. E-mail: bsrpaiva@gmail.com
Author for correspondence: Bianca Sakamoto Ribeiro Paiva, Programa de Pós-Graduação em Oncologia, Rua Antenor Duarte Vilella, 1331, Bairro Dr. Paulo Prata, Barretos, São Paulo, Brazil, CEP: 14784-400. E-mail: bsrpaiva@gmail.com
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Abstract

Context

Although the literature recognizes the participation of patients in medical decisions as an important indicator of quality, there is a lack of consensus regarding the influence of advance directives (ADs) on reducing aggressive measures during end-of-life care involving cancer patients.

Objective

A systematic review was conducted to analyze the influence of ADs on reducing aggressive end-of-life care measures for cancer patients.

Method

We searched the Medline, Embase, Web of Science, and Lilacs databases for studies published until March 2018 using the following keywords, without language restrictions: “advance directives,” “living wills,” “terminal care,” “palliative care,” “hospice care,” and “neoplasms.” Article quality was assessed using study quality assessment tools from the Department of Health and Human Services (NHLBI).

Results

A total of 1,489 studies were identified; 7 met the inclusion criteria. The studies were recently published (after 2014, 71.4%). Patients with ADs were more likely to die at the site of choice (n = 3) and received less chemotherapy in the last 30 days (n = 1). ADs had no impact on intensive care unit admission (n = 1) or hospitalization (n = 1). One study found an association between ADs and referral to palliative care, but other did not find the same result.

Significance of results

Of the seven articles found, four demonstrated effects of ADs on the reduction in aggressive measures at the end of life of cancer patients. Heterogeneity regarding study design and results and poor methodological quality are challenges when drawing conclusions.

Keywords

Advance directivesLiving willsNeoplasmsPalliative careTerminal care
Type
Review Article
Information
Palliative & Supportive Care , Volume 19 , Issue 3 , June 2021 , pp. 348 - 354
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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