Shin Hye Yoo1, Jihye Lee2, Jung Hun Kang3, Chi Hoon Maeng4, Yu Jung Kim5, Eun-Kee Song6, Youngil Koh1, Hwan-Jung Yun7, Hyun-Jeong Shim8, Jung Hye Kwon9, Eun Mi Nam10, EunKyo Kang11, Jiyeon Choo11, Young Ho Yun12,13,14. 1. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. 2. Department of Medical Informatics, Seoul National University College of Medicine, Seoul, South Korea. 3. Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, South Korea. 4. Division of Medical Oncology-Hematology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, South Korea. 5. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea. 6. Division of Hematology/Oncology, Chonbuk National University Medical School, Jeonju, South Korea. 7. Department of Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea. 8. Division of Hematology and Medical Oncology, Department of Internal Medicine, Chonnam National University School of Medicine, Hwasun, South Korea. 9. Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea. 10. Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea. 11. Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea. 12. Department of Medical Informatics, Seoul National University College of Medicine, Seoul, South Korea. lawyun08@gmail.com. 13. Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea. lawyun08@gmail.com. 14. Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea. lawyun08@gmail.com.
Abstract
PURPOSE: Little has been determined regarding the association between patients' and families' illness understanding and preferences for medical care. We aimed to evaluate the association of illness understanding with advance care planning (ACP) and preferences for end-of-life care, such as aggressive care, early palliative care (EPC), and hospice care, among advanced cancer patients and their family caregivers. METHODS: Patients were recruited for a prospective cohort study at outpatient and inpatient facilities in nine university hospitals in Korea (n = 150), and their primary family caregivers were also asked to participate (n = 101). Data on ACP and end-of-life care preferences were collected only at baseline in the cohort study with optional questions and were used to analyze these study results. RESULTS: Patients with illness understanding were more likely to have documented physician orders for life-sustaining treatment (POLSTs) (adjusted odds ratio [aOR] of 4.94) and to have discussed ACP with their families (aOR 2.15) than those who did not. Being expected to live for several months, they were unlikely to prefer active treatment. Caregivers understanding patients' illness were more likely to write advance directives (ADs) and to discuss ACP; furthermore, they had already discussed ACP with family members. They did not prefer active treatment or life-sustaining treatments when their family members were expected to die within a few weeks. There was no significant association between illness understanding and preferences for EPC. CONCLUSION: Accurately recognizing an incurable disease is associated with preferences for more ACP and less aggressive care but not with preferences for EPC or hospice care among both advanced cancer patients and their family caregivers.
PURPOSE: Little has been determined regarding the association between patients' and families' illness understanding and preferences for medical care. We aimed to evaluate the association of illness understanding with advance care planning (ACP) and preferences for end-of-life care, such as aggressive care, early palliative care (EPC), and hospice care, among advanced cancerpatients and their family caregivers. METHODS:Patients were recruited for a prospective cohort study at outpatient and inpatient facilities in nine university hospitals in Korea (n = 150), and their primary family caregivers were also asked to participate (n = 101). Data on ACP and end-of-life care preferences were collected only at baseline in the cohort study with optional questions and were used to analyze these study results. RESULTS:Patients with illness understanding were more likely to have documented physician orders for life-sustaining treatment (POLSTs) (adjusted odds ratio [aOR] of 4.94) and to have discussed ACP with their families (aOR 2.15) than those who did not. Being expected to live for several months, they were unlikely to prefer active treatment. Caregivers understanding patients' illness were more likely to write advance directives (ADs) and to discuss ACP; furthermore, they had already discussed ACP with family members. They did not prefer active treatment or life-sustaining treatments when their family members were expected to die within a few weeks. There was no significant association between illness understanding and preferences for EPC. CONCLUSION: Accurately recognizing an incurable disease is associated with preferences for more ACP and less aggressive care but not with preferences for EPC or hospice care among both advanced cancerpatients and their family caregivers.
Entities:
Keywords:
Advance care planning; Advanced cancer; Caregiver; End-of-life care; Prognosis
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