Fur-Hsing Wen1, Jen-Shi Chen2, Wen-Cheng Chang2, Wen-Chi Chou2, Chia-Hsun Hsieh2, Siew Tzuh Tang2,3. 1. 1 Department of International Business, Soochow University, Taipei. 2. 2 Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan. 3. 3 Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiugn.
Abstract
BACKGROUND: Factors facilitating/hindering concordance between preferred and received life-sustaining treatments may be distorted if preferences and predictors are measured long before death. AIM: To examine factors facilitating/hindering concordance between cancer patients' preferred and received life-sustaining-treatment states in their last 6 months. DESIGN: Longitudinal, observational design. SETTING/PARTICIPANTS: States of preferred and received life-sustaining treatments (cardio-pulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, and nasogastric tube feeding) were examined in 218 Taiwanese cancer patients by a latent transition model with hidden Markov modeling. Multivariate logistic regression modeling was used to examine factors facilitating/hindering concordance between preferred and received life-sustaining-treatment states. RESULTS: Concordance between preferred and received life-sustaining-treatment states was poor (40.8%, kappa value (95% confidence interval): 0.05 [-0.03, 0.14]). Patients who accurately understood their prognosis and preferred comfort care were significantly more likely to receive preferred life-sustaining treatments before death than those who did not know their prognosis but wanted to know, those who were uniformly uncertain about what life-sustaining treatments they preferred to receive, and those who preferred nutritional support but declined other life-sustaining treatments. Patient age, physician-patient end-of-life-care discussions, symptom distress, and functional dependence were not associated with concordance between preferred and received life-sustaining-treatment states. CONCLUSION: Prognostic awareness and preferred states of life-sustaining treatments were significantly associated with concordance between preferred and received life-sustaining-treatment states. Personalized interventions should be developed to cultivate terminally ill cancer patients' accurate prognostic awareness, allowing them to formulate realistic life-sustaining-treatment preferences and facilitating their receiving value-concordant end-of-life care.
BACKGROUND: Factors facilitating/hindering concordance between preferred and received life-sustaining treatments may be distorted if preferences and predictors are measured long before death. AIM: To examine factors facilitating/hindering concordance between cancerpatients' preferred and received life-sustaining-treatment states in their last 6 months. DESIGN: Longitudinal, observational design. SETTING/PARTICIPANTS: States of preferred and received life-sustaining treatments (cardio-pulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, and nasogastric tube feeding) were examined in 218 Taiwanese cancerpatients by a latent transition model with hidden Markov modeling. Multivariate logistic regression modeling was used to examine factors facilitating/hindering concordance between preferred and received life-sustaining-treatment states. RESULTS: Concordance between preferred and received life-sustaining-treatment states was poor (40.8%, kappa value (95% confidence interval): 0.05 [-0.03, 0.14]). Patients who accurately understood their prognosis and preferred comfort care were significantly more likely to receive preferred life-sustaining treatments before death than those who did not know their prognosis but wanted to know, those who were uniformly uncertain about what life-sustaining treatments they preferred to receive, and those who preferred nutritional support but declined other life-sustaining treatments. Patient age, physician-patient end-of-life-care discussions, symptom distress, and functional dependence were not associated with concordance between preferred and received life-sustaining-treatment states. CONCLUSION: Prognostic awareness and preferred states of life-sustaining treatments were significantly associated with concordance between preferred and received life-sustaining-treatment states. Personalized interventions should be developed to cultivate terminally ill cancerpatients' accurate prognostic awareness, allowing them to formulate realistic life-sustaining-treatment preferences and facilitating their receiving value-concordant end-of-life care.
Authors: Naomi C A van der Velden; Hanneke W M van Laarhoven; Sjaak A Burgers; Lizza E L Hendriks; Filip Y F L de Vos; Anne-Marie C Dingemans; Joost Jansen; Jan-Maarten W van Haarst; Joyce Dits; Ellen Ma Smets; Inge Henselmans Journal: BMC Cancer Date: 2022-09-01 Impact factor: 4.638
Authors: Deborah A Forst; Kit Quain; Sophia L Landay; Maya Anand; Emilia Kaslow-Zieve; Michelle M Mesa; Jamie M Jacobs; Jorg Dietrich; Michael W Parsons; Nora Horick; Joseph A Greer; Tracy T Batchelor; Vicki A Jackson; Areej El-Jawahri; Jennifer S Temel Journal: Neurooncol Pract Date: 2020-04-17