Abstract In the coming weeks and months SARS-CoV-2 may ravage countries with weak health systems and populations disproportionately affected by HIV, tuberculosis (TB), and other infectious diseases. Without safeguards and proper attention to global health equity and justice, the effects of this pandemic are likely to exacerbate existing health and socio-economic inequalities. This paper argues that achieving global health equity in the context of COVID-19 will require that notions of reciprocity and relational equity are introduced to the response.
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To report preliminary results of a randomised controlled trial looking at the effect of a formal advance care planning intervention (ACP) for patients with incurable cancer.
Method
334 patients, who have incurable cancer with disease progression after 1st line chemotherapy and an expected survival of 3–12 months, as well as their nominated family or friend, will be randomised to receive usual care or usual care plus ACP. Knowledge of and compliance with end of life wishes will be assessed. Patient and family or friend satisfaction with care, communication with healthcare providers and the mental health outcomes of the family member or friend will also be assessed.
Result
95 participant dyads (of 334) have been randomised to the study (data available for 89). Participants had a median age of 63 (SD = 10) with a mean oncologist estimated median survival of 7.7 months (SD = 2.9). At baseline, 24.7% reported any communication at all with their oncologist regarding their EOL care preferences. At 8 week follow up (n = 47), the results were similar at 23.4%. At baseline 55% and at 8 weeks 76.6% reported communication with their family regarding their EOL care. 5.7% at baseline vs 36.2% at 8 weeks had written their wishes down in a formal way. All reported the quality of the ACP discussion to be 'good', 'very good' or 'excellent'.
Conclusion
This study will provide valuable data on end of life communication between patients, family members and oncologists. ACP discussions appear to be acceptable and may be contributing to increased discussion regarding EOL wishes, over time.
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