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

Abstract: Adequate knowledge of prognosis is a prerequisite for planning appropriate end-of-life (EOL) care. However, questions remain about whether the association between prognostic under- standing 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 prefer- ences, and identified correlates of accurate prognostic understanding.

Methods: A cross-sectional survey of 2452 terminally ill cancer patients from 23 hospitals through- out 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 mas- sage, intubation, and mechanical ventilation support, but increased preference for hospice care. Par- ticipants 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 likeli- hood 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. Interven- tions should be developed to improve accurate prognostic understanding, thus facilitating informed EOL-care decisions that may limit the use of aggressive interventions. 

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