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Author's Reply To: Patient-centered Medicine In Palliative Cancer Care: The Impossible Choice Between Physician's Responsibility And Patient's Preferences

S. Gori, V. Zagonel
Published 2017 · Medicine

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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to all in the illness trajectory that needs to be shared with the patient, especially when anticancer treatments are no longer active.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. Disclosures
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