Can End-of-Life Planning Increase Control for Cancer Patients?

Research shows that patients have an interest and want to discuss end-of-life planning and concerns. However, these conversations often do not take place due to patient or physician discomfort with the topic, said Savannah Geske, PhD, a clinical psychologist with Saint Luke’s Health System, in Kansas City, Mo. However, as of 2019, 72% of hospitals with 50 or more beds nationwide have palliative care programs.

Clinical Oncology News’ recent article entitled “End-of-Life Planning Gives Cancer Patients Sense of Completion, Control” reports that to address these discrepancies, Dr. Geske and clinical psychologist Kadie Harry, PhD, started a virtual end-of-life planning group with patients at St. Luke’s. During four weekly, 90-minute small-group sessions, the group reviews components of the workbook “The Last Chapter: Documenting your Pre- and Post-Death Decisions,” by Therese McKechnie. Each session focuses on a different section of the book.

1. The first session, “When Death Occurs,” covers topics like funeral planning, writing an obituary and leaving a legacy.
2. The second session, “As Death Approaches,” asks patients to think about their religious and spiritual beliefs, comfort measures at end of life and thoughts about using hospice or palliative care.
3. The third session, “Advance Directives,” discusses living wills, powers of attorney for healthcare and finances and organ and body donation.
4. The final session, “Closing Your Estate” and “All Your Data,” helps patients organize personal, medical, property, financial, employment and other information and contacts.

Participants had statistically significant improvements in relationships with providers, feelings of life completion and decreases in death-related anxiety, Dr. Geske said. Most participants said the program simplified end-of-life planning and motivated them to discuss end-of-life decisions with loved ones.

“They discussed a recurring pattern of first, a strong feeling of not wanting to do something, then engaging with this feeling through the workbook or with group members, and finally a sense of empowerment and accomplishment,” Dr. Geske said. Participants also reported that peer support was helpful in coming to terms with their mortality, she said, especially during the COVID-19 pandemic.

The study’s findings are consistent with prior work in the field. In one nurse-led advance care planning session, patient and family member response was “overwhelmingly positive, with participants citing opportunities for group discussion and inclusion of family caregivers as important.”

Reference: Clinical Oncology News (Feb. 28, 2022) “End-of-Life Planning Gives Cancer Patients Sense of Completion, Control”