Accurate Prognostic Awareness Facilitates, Whereas Better Quality of Life and More Anxiety Symptoms Hinder End-of-Life Care Discussions: A Longitudinal Survey Study in Terminally Ill Cancer Patients' Last Six Months of Life
Published in
Journal of Pain & Symptom Management, December 2017
Terminally ill cancer patients do not engage in end-of-life (EOL)-care discussions or do so only when death is imminent, despite guidelines for EOL-care discussions early in their disease trajectory. Most studies on patient-reported EOL-care discussions are cross-sectional without exploring the evolution of EOL-care discussions as death approaches. Cross-sectional studies cannot determine the direction of association between EOL-care discussions and patients' prognostic awareness, psychological well-being, and quality of life (QOL).
We examined the evolution and associations of accurate prognostic awareness, functional dependence, physical and psychological symptom distress, and QOL with patient-physician EOL-care discussions among 256 terminally ill cancer patients in their last 6 months by hierarchical generalized linear modeling with logistic regression and by arranging time-varying modifiable variables and EOL-care discussions in a distinct time sequence.
The prevalence of physician-patient EOL-care discussions increased as death approached (9.2%, 11.8%, and 18.3% for 91-180, 31-90, and 1-30 days before death, respectively) but only reached significance in the last month. Accurate prognostic awareness facilitated subsequent physician-patient EOL-care discussions, whereas better patient-reported QOL and more anxiety symptoms hindered such discussions. The likelihood of EOL-care discussions was not associated with levels of physical symptom distress, functional dependence, or depressive symptoms.
Physician-patient EOL-care discussions for terminally ill Taiwanese cancer patients remain uncommon even when death approaches. Physicians should facilitate EOL-care discussions by cultivating patients' accurate prognostic awareness early in their cancer trajectory when they are physically and psychologically competent, with better QOL, thus promoting informed and value-based EOL-care decision-making.
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