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Shen MJ, Prigerson HG, Ratshikana-Moloko M, Mmoledi K, Ruff P, Jacobson JS, Neugut AI, Amanfu J, Cubasch H, Wong M, Joffe M, Blanchard C. Illness Understanding and End-of-Life Care Communication and Preferences for Patients With Advanced Cancer in South Africa. J Glob Oncol 2019; 4:1-9. [PMID: 30241251 PMCID: PMC6223439 DOI: 10.1200/jgo.17.00160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose The understanding of patients with cancer of their condition and their wishes regarding care as they approach end of life (EoL) have been studied more in high-income countries than in low- and middle-income countries (LMICs). Patients and Methods Data were analyzed from a cohort study (N = 221) of patients with advanced cancer who were recruited from a palliative care center in Soweto, South Africa (LMIC), between May 2016 and June 2017. Patients were asked about their understanding of their illness, estimated life expectancy, EoL care communication, and EoL care preferences. Results Only 13 patients (5.9%) acknowledged that they were terminally ill; nine patients (4.1%) estimated accurately that they had months, not years, left to live. A total of 216 patients (97.7%) reported that they had not had an EoL care discussion with their physician, and 170 patients (76.9%) did not want to know their prognosis even if the doctor knew it. Most patients preferred comfort care (72.9%; n = 161) to life-extending care (14.0%; n = 31), and did not want to be kept alive using extreme measures (80.5%; n = 178) or have their doctors do everything possible to extend their lives (78.3%; n = 173). Finally, 127 patients (57.5%) preferred to die at home, and 51 (23.1%) preferred to die in the hospital. Most patients (81.0%; n = 179) had funeral plans. Conclusion South African patients demonstrated less awareness of the fact that they were terminally ill, were less likely to have discussed their prognosis with their doctor, and more strongly preferred comfort care to life-extending EoL care than US and other LMIC patients in prior research. These differences highlight the need for culturally appropriate, patient-centered EoL care for South African patients with advanced cancer as well as to determine individual preferences and needs in all EoL settings.
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Affiliation(s)
- Megan Johnson Shen
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Holly G Prigerson
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Mpho Ratshikana-Moloko
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Keletso Mmoledi
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Paul Ruff
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Judith S Jacobson
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Alfred I Neugut
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Jamila Amanfu
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Herbert Cubasch
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Michelle Wong
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Maureen Joffe
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Charmaine Blanchard
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
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