Elderly Outpatients' Attitudes toward Care in Terminal Stage Disease

Responses to a questionnaire regarding 1) dying at home, 2) being told of a diagnosis of cancer, and 3) hydration and nutriton, uses of narcotics for pain and dyspnea, oxygen treatment, antibiotics, transfusion and surgery in a near-vegetative state was obtained from 562 outpatients (73.4±8.6 years: mean±SD, men: women=1.0:1.7). Dying at home was preferred by 64% and hospital death by 24%. Sixty and 65% of patients chose to be told of the diagnosis either in the last 3 months or at the early curable stage of the disease respectively, while only 53% wanted to be told precisely about their remaining estimated survival. If their spouse had terminal stage disease, 42% chose to inform the spouse of the diagnosis. Eighty percent chose palliative care, while 9.3% wished for intensive life-sustaining treatment. In a near vegetative state, tube feeding was desired by 8.7% and intravenous drip infusion by 39%; narcotics for pain or dyspnea were desired by 40 and 52%; oxygen or tracheostomy plus a respirator for dyspnea was chosen in 56 and 11% respectively; antibiotics for treatment of infection was desired by 38%; surgery for intestinal obstruction by 36 percent; transfusion for bleeding by 29%; and no treatment in any situation by 21%. Commonly expressed wishes were for a natural death, dying at home, and being told of the status of their disease, while details of palliative care were not well recognized.