title: Peaceful awareness in patients with advanced cancer.
abstract: BACKGROUND
  Previous studies have shown that prognostic awareness may be harmful to mental health yet beneficial for end of life care planning. The effects of prognostic awareness coupled with a sense of inner peace are unknown.
  
  
  METHODS
  In the multisite, longitudinal Coping with Cancer Study, 280 patients with advanced cancer were interviewed at baseline. Patients defining themselves as "terminally ill" and/or "at peace" most days were paired with others on sociodemographic, mental health and advance care planning. Primary caregivers of deceased patients were interviewed 6 months postloss and compared on their physical and mental health and their perceptions of patients' end-of-life care and death.
  
  
  RESULTS
  Overall, 17.5% of patients reported being both peaceful and aware. Peacefully aware patients had lower rates of psychological distress and higher rates of advance care planning (e.g., completing do-not-resuscitate [DNR] orders, advance care planning discussions with physicians) than those who were not peacefully aware. Additionally, peacefully aware patients had the highest overall quality of death as reported by their caretakers in a postmortem evaluation. Surviving caregivers of peacefully aware patients were more physically and mentally healthy 6 months postloss than caregivers of patients who were "aware" but not peaceful.
  
  
  CONCLUSIONS
  Patients with advanced cancer who are peacefully aware have better mental health and quality of death outcomes, and their surviving caregivers have better bereavement outcomes. Peaceful awareness is associated with modifiable aspects of medical care (e.g., discussions about terminal treatment preferences).
authors.affiliation: Center for Psychooncology and Palliative Care Research, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA. alaka_ray@dfci.harvard.edu
authors.forename: Alaka
authors.initials: A
authors.lastname: Ray
authors.forename: Susan D
authors.initials: SD
authors.lastname: Block
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Friedlander
authors.forename: Baohui
authors.initials: B
authors.lastname: Zhang
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001364:Awareness; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D012720:Severity of Illness Index