ArticleSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2021
Prevalence of ethical dilemmas in advanced cancer patients (secondary analysis of the PALCOM study).
Article in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Relevance of clinical ethics support services in specialized outpatient palliative care teams and inpatient hospices.BMC palliative care · 2026Article
- Healthcare professionals' perceptions of ethical issues in palliative sedation: A moral case deliberation study in eight European countries.Palliative care and social practice · 2026Article
- Latent profile analysis of spousal information concealment in patients with cancer: A cross-sectional study.Asia-Pacific journal of oncology nursing · 2025Article
- Article
- Ethical issues in communication in a tertiary oncology center: exploratory survey.Frontiers in psychology · 2025Article
- What ethical conflicts do internists in Spain, México and Argentina encounter? An international cross-sectional observational study based on a self-administrated survey.BMC medical ethics · 2024Observational
- Article
- Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients.Cancers · 2023Article
- Information concealment in palliative patients: Development and pilot study of a new scale for caregivers.Health & social care in the community · 2022Article
- Gender and Observed Complexity in Palliative Home Care: A Prospective Multicentre Study Using the HexCom Model.International journal of environmental research and public health · 2021Observational
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Authors and funding
12 authors.
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Abstract
purposeThe main aim of this study was to determine the prevalence of ethical dilemmas in the end-of-life process in advanced cancer patients.
methodsWe carried out a multicenter, cross-sectional, observational, prospective study in a cohort of cancer patients whose life expectancy was ≤ 6 months. We recorded sociodemographic characteristics, diagnosis of cancer, symptom burden, cognitive and functional status, emotional impact, and sociofamilial risk factors. The main outcome measure was the detection of ethical dilemmas, based on the following definition: conflict in decision-making during the end-of-life process that involves the need to choose between morally acceptable opposing options, where none is clearly preferable to another.
resultsWe included 324 patients (mean age, 69 years; 58% men). We identified 117 dilemmas in 90 patients (27.8%). The dilemmas detected were as follows: (a) conflicts of information (adaptive denial, conspiracy of silence, information exceeding patient's desired limit), 15.7%; (b) discrepancies in proportionality (discussion on futility, rejection of treatment, withdrawal of life support measures), 16.7%; (c) unrealistic expectations about the outcome of clinical trials, 2.5%; and (d) request for euthanasia or medically assisted suicide, 1.2%. We observed a greater prevalence of ethical dilemmas in men, in patients receiving active cancer treatment, and in patients with emotional distress (p < 0.05).
conclusionsThe prevalence of ethical dilemmas during the end-of-life process in cancer patients is relevant. Most dilemmas were associated directly or indirectly with respect for patient autonomy. In this context, the communication skills of the health professionals and advanced care planning take on a key role.
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