Associations between accurate prognostic understanding and end-of-life care preferences and its correlates among Taiwanese terminally ill cancer patients surveyed in 2011-2012

Siew Tzuh Tang, Tsang Wu Liu, Jyh-Ming Chow, Chang Fang Chiu, Ruey Kuen Hsieh, Chen H. Chen, Li Ni Liu, Wei Lien Feng

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective Adequate knowledge of prognosis is a prerequisite for planning appropriate end-of-life (EOL) care. However, questions remain about whether the association between prognostic understanding and EOL-care intensity reflects terminally ill cancer patients' preferences for EOL care. This study investigated the associations between accurate prognostic understanding and EOL-care preferences, and identified correlates of accurate prognostic understanding. Methods A cross-sectional survey of 2452 terminally ill cancer patients from 23 hospitals throughout Taiwan. Results Nearly half the participants (49.80%) accurately understood their prognosis. These patients were significantly more likely to prefer comfort-oriented care as their goal for EOL care, but less likely to prefer life-prolonging treatments. Accurately understanding prognosis decreased the likelihood of preferring intensive care unit care, cardiac pulmonary resuscitation, cardiac massage, intubation, and mechanical ventilation support, but increased preference for hospice care. Participants were significantly more likely to accurately understand their prognosis if they were male, younger, better educated, with a stronger preference for physicians to disclose their prognosis to them, and receiving care at a hospital accredited as a medical center and in northwest Taiwan. The likelihood of accurate prognostic understanding was lower for patients recently (≤12 months) diagnosed with cancers with better prognosis and hematologic malignancies than for lung cancer patients. Conclusions Accurately understanding prognosis is associated with fewer preferences for life-sustaining treatments and is correlated with both patient and institutional characteristics. Interventions should be developed to improve accurate prognostic understanding, thus facilitating informed EOL-care decisions that may limit the use of aggressive interventions.

Original languageEnglish
Pages (from-to)780-787
Number of pages8
JournalPsycho-Oncology
Volume23
Issue number7
DOIs
Publication statusPublished - 2014

Fingerprint

Terminally Ill
Terminal Care
Neoplasms
Taiwan
Heart Massage
Hospice Care
Patient Preference
Hematologic Neoplasms
Artificial Respiration
Intubation
Resuscitation
Intensive Care Units
Lung Neoplasms
Cross-Sectional Studies
Physicians
Lung
Therapeutics

Keywords

  • cancer
  • end-of-life care
  • oncology
  • preferences for end-of-life care
  • prognostic understanding

ASJC Scopus subject areas

  • Oncology
  • Psychiatry and Mental health
  • Experimental and Cognitive Psychology
  • Medicine(all)

Cite this

Associations between accurate prognostic understanding and end-of-life care preferences and its correlates among Taiwanese terminally ill cancer patients surveyed in 2011-2012. / Tang, Siew Tzuh; Liu, Tsang Wu; Chow, Jyh-Ming; Chiu, Chang Fang; Hsieh, Ruey Kuen; Chen, Chen H.; Liu, Li Ni; Feng, Wei Lien.

In: Psycho-Oncology, Vol. 23, No. 7, 2014, p. 780-787.

Research output: Contribution to journalArticle

Tang, Siew Tzuh ; Liu, Tsang Wu ; Chow, Jyh-Ming ; Chiu, Chang Fang ; Hsieh, Ruey Kuen ; Chen, Chen H. ; Liu, Li Ni ; Feng, Wei Lien. / Associations between accurate prognostic understanding and end-of-life care preferences and its correlates among Taiwanese terminally ill cancer patients surveyed in 2011-2012. In: Psycho-Oncology. 2014 ; Vol. 23, No. 7. pp. 780-787.
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AU - Hsieh, Ruey Kuen

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N2 - Objective Adequate knowledge of prognosis is a prerequisite for planning appropriate end-of-life (EOL) care. However, questions remain about whether the association between prognostic understanding and EOL-care intensity reflects terminally ill cancer patients' preferences for EOL care. This study investigated the associations between accurate prognostic understanding and EOL-care preferences, and identified correlates of accurate prognostic understanding. Methods A cross-sectional survey of 2452 terminally ill cancer patients from 23 hospitals throughout Taiwan. Results Nearly half the participants (49.80%) accurately understood their prognosis. These patients were significantly more likely to prefer comfort-oriented care as their goal for EOL care, but less likely to prefer life-prolonging treatments. Accurately understanding prognosis decreased the likelihood of preferring intensive care unit care, cardiac pulmonary resuscitation, cardiac massage, intubation, and mechanical ventilation support, but increased preference for hospice care. Participants were significantly more likely to accurately understand their prognosis if they were male, younger, better educated, with a stronger preference for physicians to disclose their prognosis to them, and receiving care at a hospital accredited as a medical center and in northwest Taiwan. The likelihood of accurate prognostic understanding was lower for patients recently (≤12 months) diagnosed with cancers with better prognosis and hematologic malignancies than for lung cancer patients. Conclusions Accurately understanding prognosis is associated with fewer preferences for life-sustaining treatments and is correlated with both patient and institutional characteristics. Interventions should be developed to improve accurate prognostic understanding, thus facilitating informed EOL-care decisions that may limit the use of aggressive interventions.

AB - Objective Adequate knowledge of prognosis is a prerequisite for planning appropriate end-of-life (EOL) care. However, questions remain about whether the association between prognostic understanding and EOL-care intensity reflects terminally ill cancer patients' preferences for EOL care. This study investigated the associations between accurate prognostic understanding and EOL-care preferences, and identified correlates of accurate prognostic understanding. Methods A cross-sectional survey of 2452 terminally ill cancer patients from 23 hospitals throughout Taiwan. Results Nearly half the participants (49.80%) accurately understood their prognosis. These patients were significantly more likely to prefer comfort-oriented care as their goal for EOL care, but less likely to prefer life-prolonging treatments. Accurately understanding prognosis decreased the likelihood of preferring intensive care unit care, cardiac pulmonary resuscitation, cardiac massage, intubation, and mechanical ventilation support, but increased preference for hospice care. Participants were significantly more likely to accurately understand their prognosis if they were male, younger, better educated, with a stronger preference for physicians to disclose their prognosis to them, and receiving care at a hospital accredited as a medical center and in northwest Taiwan. The likelihood of accurate prognostic understanding was lower for patients recently (≤12 months) diagnosed with cancers with better prognosis and hematologic malignancies than for lung cancer patients. Conclusions Accurately understanding prognosis is associated with fewer preferences for life-sustaining treatments and is correlated with both patient and institutional characteristics. Interventions should be developed to improve accurate prognostic understanding, thus facilitating informed EOL-care decisions that may limit the use of aggressive interventions.

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