title: Determinants of patient-family caregiver congruence on preferred place of death in taiwan.
abstract: BACKGROUND
  Patient-family caregiver congruence on preferred place of death not only increases the likelihood of dying at home but also contributes significantly to terminally ill cancer patients' quality of life.
  
  
  OBJECTIVE
  To examine the determinants of patient-family caregiver congruence on the preferred place of death in Taiwan.
  
  
  METHODS
  Patient-family caregiver dyads (n=1,108) were surveyed on preferences and needs for end-of-life (EOL) care. Determinants of congruence on preferences were identified by multivariate logistic regression.
  
  
  RESULTS
  Patient-caregiver dyads achieved 78.1% agreement on the preferred place of death. The kappa coefficient of congruence was 0.55 (95% confidence interval [CI]=0.50, 0.60). The extent of patient-family caregiver congruence on preferred place of death increased with the patient's higher functional dependence (adjusted odds ratio [AOR] and 95% CI=1.04 [1.02, 1.05]), higher patient-rated importance for dying at preferred place of death (AOR [95% CI]=1.60 [1.43, 1.79]), and having a spousal caregiver (AOR [95% CI]=1.62 [1.14, 2.31]). Other determinants of patient-family caregiver congruence included patient age (AOR [95% CI]=1.01 [1.00, 1.03]), patient-family concordance on preferred EOL care options (AOR=1.68-1.73), patient knowledge of prognosis (AOR [95% CI]=0.68 [0.48, 0.97]), and impact of caregiving on the family caregiver's life (AOR [95% CI]=0.98 [0.96, 0.99]).
  
  
  CONCLUSIONS
  Increasing patient-family congruence on preferred place of death not only requires knowledge of the patient's prognosis and advance planning by both parties but also depends on family caregivers endorsing patient preferences for EOL care options and ensuring that supporting patients dying at home does not create an intolerable burden for family caregivers.
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China. sttang@mail.cgu.edu.tw
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
authors.forename: Cheryl Chia-Hui
authors.initials: CC
authors.lastname: Chen
authors.forename: Woung-Ru
authors.initials: WR
authors.lastname: Tang
authors.forename: Tsang-Wu
authors.initials: TW
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D017028:Caregivers; D003430:Cross-Sectional Studies; D003643:Death; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057240:Patient Preference; D010361:Patients; D011795:Surveys and Questionnaires; D013624:Taiwan; D013727:Terminal Care; D019452:Terminally Ill