End-of-life decision-making in cancer patients is often surrounded by clinical, ethical and psychological conflicts and can therefore be a challenging process for patients, relatives and the medical team. The aim of the EPAL study (Ethics policy for advanced care planning and limiting treatment) is the development and implementation of a clinical practice guideline about limiting life-prolonging treatment as well as the evaluation of its impact on medical practice in the Dept. of Internal Medicine, which runs a comprehensive cancer center at the Munich University Hospital, with respect to the following criteria:
- knowledge and consideration of the patient's wishes,
- reduction of conflicts in decision-making,
- better transparency through standardized documentation and
- reduction of the burden on the health care team.
In order to identify changes in these variables we use a pre-post study design before and after implementation of the policy. The epistemological aim is to contribute to the discussion of methods and to the evaluation of ethical guidelines. Although guidelines are common in medical practice, the influence of ethics policies on clinical decision-making is so far unclear.