Would they do it again? Final treatment decisions in malignant brain tumour patients-a caregiver's perspective

Purpose Overall survival of malignant brain tumour patients has significantly been increased over the last years. However, therapy remains palliative, and side effects should be balanced. Once terminal phase is entered, both patients and caregivers may find it hard to accept, and further therapies are demanded. But little is known about this highly sensitive period. Therefore, we analysed the last therapy decisions from the family caregiver's perspective. Would they support their beloved ones in the same way or would they now recommend a different therapy decision? Methods Caregivers of deceased malignant brain tumour patients, treated at our neurooncological centre between 2011 and 2017, were included. We designed a questionnaire to analyse the impact of the last therapy decision (resection, chemotherapy, radiotherapy), focusing on probable repeat of the choice taken and general therapy satisfaction. Independent variables, for example satisfaction with therapy, were analysed using linear regression analysis, the coefficient of determination R-2 and the standardized regression coefficient beta. The binary logistic regression analyses were taken to illustrate relationships with the dichotomously scaled outcome parameter re-choice of therapy. Odds ratio analyses were used to determine the strength of a relationship between two characteristics. Results Data from 102 caregivers (life partners (70.6%)) were analysed retrospectively. Each 40% of patients died in a hospice or at home (20% in a hospital). In 67.6% the last therapy was chemotherapy followed by radiotherapy (16.7%) and surgery (15.7%). A positive evaluation of the last therapy was significantly correlated to re-choosing of respective therapy (chemo-/radiotherapy: p = 0.000) and satisfaction with informed consent (p = 0.000). Satisfaction regarding interpersonal contact was significantly correlated to satisfaction with resection (p = 0.000) and chemotherapy (p = 0.000 27 caregivers (28.7%) felt overburdened with this situation). Conclusion This analysis demonstrates a significant correlation between a positive relation of patient/caregiver/physician and the subjective perception of the latest therapy. It underlines the central role of caregivers, who should be involved in therapy discussions. Neurooncologists should be specially trained in communication and psycho-oncology.

Automated summary

The last therapy decision for malignant brain tumor patients greatly affects the caregivers' perspective. Caregivers are more likely to support the same therapy decision if they had a positive evaluation of the last therapy and were satisfied with the informed consent. Good interpersonal contact is crucial for satisfaction with surgery and chemotherapy. Caregivers should play an important role in therapy discussions.