Abstract
Context
Patients can prepare for end of life and their forthcoming death to enhance the quality
of dying.
Objectives
We aimed to longitudinally evaluate the never-before-examined associations of cancer
patients' death-preparedness states by conjoint cognitive prognostic awareness and
emotional preparedness for death with psychological distress, quality of life (QOL),
and end-of-life care received.
Methods
In this cohort study, we simultaneously evaluated associations of four previously
identified death-preparedness states (no-death-preparedness, cognitive-death-preparedness-only,
emotional-death-preparedness-only, and sufficient-death-preparedness states) with
anxiety symptoms, depressive symptoms, and QOL over 383 cancer patients’ last six
months and end-of-life care received in the last month using multivariate hierarchical
linear modeling and logistic regression modeling, respectively. Minimal clinically
important differences (MCIDs) have been established for anxiety- (1.3–1.8) and depressive-
(1.5–1.7) symptom subscales (0–21 Likert scales).
Results
Patients in the no-death-preparedness and cognitive-death-preparedness-only states
reported increases in anxiety symptoms and depressive symptoms that exceed the MCIDs,
and a decline in QOL from those in the sufficient-death-preparedness state. Patients
in the emotional-death-preparedness-only state were more (OR [95% CI]=2.38 [1.14,
4.97]) and less (OR [95% CI]=0.38 [0.15, 0.94]) likely to receive chemotherapy/immunotherapy
and hospice care, respectively, than those in the sufficient-death-preparedness state.
Death-preparedness states were not associated with life-sustaining treatments received
in the last month.
Conclusion
Conjoint cognitive and emotional preparedness for death is associated with cancer
patients’ lower psychological distress, better QOL, reduced anti-cancer therapy, and
increased hospice-care utilization. Facilitating accurate prognostic awareness and
emotional preparedness for death is justified when consistent with patient circumstances
and preferences.
Key Words
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Article info
Publication history
Published online: February 19, 2022
Accepted:
February 16,
2022
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
