講演者：Professor Mahati Chittem
https://sites.google.com/a/iith.ac.in/dr-mahati-chittem/
タイトル：Experiences of the end-of-life among patients with advanced cancers (qualitative)
アブストラクト

“How long it will be like this?” – Hopes at the end-of-life among Indian patients with advanced incurable cancer.

Mahati Chittem^a, Jaklin Eliott^b, Sravannthi Maya^a, Ian Olver^c

1. Department of Liberal Arts, Indian Institute of Technology Hyderabad, Sangareddy, Kandi, Telangana 502285, India.
2. School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide SA5005, Australia.
3. School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide SA 5005, Australia

Abstract

Objective: In India, individuals’ lives are mainly guided by culturally-driven scripts of doing right by one’s family and death is believed to be predetermined. This study aimed to understand patients’ hopes at the end of life, particularly focussing on perceptions and beliefs about do-not-resuscitate (DNR) orders and euthanasia, among Indian cancer patients with advanced incurable cancer.

Method: Indian cancer patients (n = 25) diagnosed with advanced incurable cancer and aware of their prognosis participated in semi-structured interviews exploring hopes as they approached the end-of-life. The interview also sought to understand patients’ views and beliefs about DNR orders and euthanasia. The interviews were transcribed and analysed using Interpretative Phenomenological Analysis.

Results: Two major themes were identified: (i) desire for living or dying comprising subthemes of perceptions of current responsibilities and having a fighting spirit versus feelings of despair, and (ii) God was the ultimate decision-maker of life and death. Further, patients understood the DNR order to constitute euthanasia and responded accordingly. However, patients did not talk about euthanasia openly, instead choosing to describe it within the larger framework of life and death.

Conclusions: Indian patients reaching the end-of-life valued their family responsibilities which determined their desire to live or die. Some patients reported hoping for death due to pain and resultant suffering. However, all patients believed God decided on their life and death. Therefore, it is important to consider cultural perspectives on DNR or euthanasia, and to address patients’ pain management needs towards the end-of-life.