Author’s reply to: Patient-centered medicine in palliative cancer care: the impossible choice between physician’s responsibility and patient’s preferences
Tumori 2017; 103(2): e22 - e22
Article Type: LETTER TO THE EDITOR
AuthorsStefania Gori, Vittorina Zagonel
- • Accepted on 29/12/2016
- • Available online on 16/01/2017
- • Published online on 24/03/2017
This article is available as full text PDF.
Download any of the following attachments:
We read with interest the comments of Vegni and Borghi.
For over 10 years, the AIOM has been engaged in training events and development of simultaneous care models that aim to anticipate the patient’s needs, including communication and relational aspects and EOL choices (1, 2).
The privilege of being oncologists offers us a long period to get to know our patient, with whom we share choices, and to tailor those choices on the basis of his or her needs and desires, but also based on the knowledge of prognosis, and what the doctors who have treated him or her believe to be best for that patient. This can be achieved only if we oncologists are able to establish a true relationship of care with the patient, which, during disease evolution, allows us to share the subsequent choices: the ability to gradually deal with the prognosis of the disease and, in conversations, to collect any wishes of the patient concerning EOL (3). The choice cannot be made at the EOL, but the process needs to begin early in a continuous dialogue between doctor and patient, and in a gradual sharing of decisions, anticipating EOL choices (4).
The ideal relationship between patient and oncologist is the continuation of a therapeutic alliance, which we can ethically define as care alliance, i.e., an extension of a shared agreement aimed not only at cancer therapies, but to all in the illness trajectory that needs to be shared with the patient, especially when anticancer treatments are no longer active.
Thus, shared participation in EOL choices also becomes natural, in particular therapeutic withdrawal, which is neither acceleration of death nor euthanasia, in which the waiver of further treatment is expressed not in abandonment but in accompaniment/assistance (ad sistere = stand alongside), despite the suspension of any treatments considered disproportionate or inappropriate.
In this vision, the oncologist who cared for the patient becomes the guarantor of EOL choices, and is able to decide with the patient, or, in some cases, in place of the patient (and his or her family), what is best for the patient.
Gori S Greco MT Catania C Colombo C Apolone G Zagonel V AIOM Group for the Informed Consent in Medical Oncology. A new informed consent form model for cancer patients: preliminary results of a prospective study by the Italian Association of Medical Oncology (AIOM). 2012 87 2 243 249
Catania C Zagonel V Fosser V et al. Opinions concerning euthanasia, life-sustaining treatment and acceleration of death: results of an Italian Association of Medical Oncology (AIOM) survey. 2008 19 11 1947 1954
Zagonel V Torta R Franciosi V et al; AIOM Simultaneous & Continuous Care (SCC) Task Force-ESMO-DCs. 2016 7 14 1968 1978
Zagonel V Franciosi V Brunello A et al. Position paper of the Italian Association of Medical Oncology on early palliative care in oncology practice (Simultaneous Care). 2016 0.
- Gori, Stefania [PubMed] [Google Scholar] 1, * Corresponding Author (email@example.com)
- Zagonel, Vittorina [PubMed] [Google Scholar] 2
UOC Oncologia Medica, Ospedale Sacro Cuore Don Calabria, Negrar (Verona) - Italy
UOC Oncologia Medica 1, Istituto Oncologico Veneto, IRCCS, Padova - Italy