title: Good death study of elderly patients with terminal cancer in Taiwan.
abstract: OBJECTIVE
  Over half of all terminal cancer patients in Taiwan are 65 or older, thus demonstrating the importance of terminal care for elderly people. This study investigates the good death status of elderly patients with terminal cancer, comparing the differences in the degree of good death among elderly and younger groups, and exploring the factors related to the good death score.
  
  
  METHODS
  Three hundred and sixty-six patients with terminal cancer admitted to a palliative care unit were enrolled. Two structured measurements, the good death scale and the audit scale for good death services, were used as the instruments in the study.
  
  
  RESULTS
  The scores of individual items and of the good death scale were increased significantly in both elderly (n = 206, 56.3%) and younger (n = 160, 43.7%) groups from the time of admission to just prior to death. However, the elderly group had significantly lower scores in 'awareness' (t = -3.76, P < 0.001), 'propriety' (t = -2.92, P < 0.01) and 'timeliness' (t = -2.91, P < 0.01) than the younger group prior to death. Furthermore, because of a lack of truth-telling, the elderly group also had significantly lower scores than the younger group in both 'respect for autonomy' and 'decision-making participation' (t = -2.17, P < 0.05; t = -2.21, P < 0.05, respectively). Multiple regression analysis revealed that 'respect for autonomy' (OR = 1.22, 95% CI = 0.76-1.67) and 'verbal support '(OR = 0.93, 95% CI = 0.34-1.51) were two independent correlates of the good death score in the elderly group.
  
  
  CONCLUSIONS
  The dilemma of truth-telling compromises the autonomy of the elderly patients with terminal cancer and consequently affects their good death scores. The palliative care team should emphasize the issue of truth-telling in the process of caring for terminally ill cancer patients, especially elderly patients.
authors.affiliation: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei.
authors.forename: S Y
authors.initials: SY
authors.lastname: Cheng
authors.forename: W Y
authors.initials: WY
authors.lastname: Hu
authors.forename: W J
authors.initials: WJ
authors.lastname: Liu
authors.forename: C A
authors.initials: CA
authors.lastname: Yao
authors.forename: C Y
authors.initials: CY
authors.lastname: Chen
authors.forename: T Y
authors.initials: TY
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001293:Attitude to Death; D003657:Decision Making; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026684:Personal Autonomy; D012044:Regression Analysis; D013624:Taiwan; D013727:Terminal Care / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology*; D014342:Truth Disclosure