Abstract
Dear Editor:
Identifying patient choice appears fundamental to effective palliative care delivery. Decision making includes challenges to bad information giving. 1 Some doctors believe they can preserve hope and protect the patient against severe psychological crisis by denying the information. The relationship between communication and a patient's well-being cannot be easily forejudged. 2 We analyzed the informed consent for offered palliative care and quality of life (QoL) within the first week of delivering this care.
Study participants were consecutively recruited among terminal cancer patients referred to palliative care. The data was taken twice—on admission and 7 to 10 days later. The investigation consisted of cognitive functioning assessment, patient's informed consent, and quality of life (QoL) estimation. Cognitively competent patients underwent an interview, which evaluated capability of adequate decision making. An informed consent was defined as understanding the true message, appreciation, ability to weigh the risks and benefits, and expressing the intended agreement. QoL was operationalized as life comfort and degree of life satisfaction; the assessment tool was based partly upon the QoL Uniscale 3 and partly on the Distress Thermometer. 4
Of the 255 admitted patients, 97 determined to be cognitively competent and capable of adequate decision making were enrolled for further investigation. Seventy were qualified as an informed consent group (ICG). Informed consent was not found in 27 patients, the consent lacking group (CLG). The main reason for this lack of consent was false information about the purpose of their admission (curative instead of palliative). Forty-six patients within the ICG pointed at the medical staff as the source of the information needed for informed consent. In 12 of the competent 97 patients, neither relatives nor medical staff talked with patients about the possibility and indications of receiving palliative care. Twenty received misinformation about the location and name of the ward and 33 could not count on physician's informational support. There was no difference between the ICG and CLG in QoL on admission. Only in the ICG, the QoL significantly arose during the first week of care (P=0.001). After a week, ICG patients' QoL was better than CLG patients (P=0.003).
This study confirmed that informed consent is a useful instrument to help deliver successful care. It underlines the significance of reliable information in obtaining an individual's consent for palliative care. Close communication between curative and palliative care providers is necessary.