title: Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer: prospective cohort study.
abstract: OBJECTIVE
  We conducted this study to evaluate the validity of the perception that awareness of their terminal prognosis and use of palliative care or nonuse of an intensive care unit (ICU) causes patients to die sooner than they would otherwise.
  
  
  METHODS
  In this prospective cohort study at 11 university hospitals and the National Cancer Center in Korea, we administered questionnaires to 619 consecutive patients immediately after they were determined by physicians to be terminally ill. We followed patients during 6 months after enrollment and assessed how their survival was affected by the disclosure of terminal illness and administration of palliative care or nonuse of the ICU.
  
  
  RESULTS
  In a follow-up of 481 patients and 163.8 person-years, we identified 466 deceased patients. Nineteen percent of the patients died within 1 month, while 41.3% lived for 3 months, and 17.7% lived for 6 months. Once the cancer was judged terminal, the median survival time was 69 days. On multivariate analysis, neither patient awareness of terminal status at baseline (adjusted hazard ratio [aHR], 1.20; 95% CI, 0.96 to 1.51), use of a palliative care facility (aHR, 0.96; 95% CI, 0.76 to 1.21), nor general prostration (aHR, 1.23; 95% CI, 0.96 to 1.57) was associated with reduced survival. Use of the ICU (aHR, 1.47; 95% CI, 1.06 to 2.05) and poor Eastern Cooperative Oncology Group performance status (aHR, 1.37; 95% CI, 1.10 to 1.71) were significantly associated with poor survival.
  
  
  CONCLUSIONS
  Patients' being aware that they are dying and entering a palliative care facility or ICU does not seem to influence patients' survival.
authors.affiliation: Cancer Management Branch, Research Institute, National Cancer Center, 809, Madu-dong, Ilsan-gu, Goyang-si, Gyeonggi-do, 411-769, Korea. lawyun08@ncc.re.kr
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Yun
authors.forename: Myung Kyung
authors.initials: MK
authors.lastname: Lee
authors.forename: Seon Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Kyung Hae
authors.initials: KH
authors.lastname: Jung
authors.forename: Young Rok
authors.initials: YR
authors.lastname: Do
authors.forename: Samyong
authors.initials: S
authors.lastname: Kim
authors.forename: Dae Seog
authors.initials: DS
authors.lastname: Heo
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Choi
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Park
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Jeong
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Kang
authors.forename: Si-Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Jungsil
authors.initials: J
authors.lastname: Ro
authors.forename: Jung Lim
authors.initials: JL
authors.lastname: Lee
authors.forename: Sook Ryun
authors.initials: SR
authors.lastname: Park
authors.forename: Sohee
authors.initials: S
authors.lastname: Park
mesh_terms: D000368:Aged; D001293:Attitude to Death; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D015331:Cohort Studies; D003422:Critical Care / Q000523:psychology*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care / Q000523:psychology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology*; D014342:Truth Disclosure