title: Preparation for the end of life in patients with advanced cancer and association with communication with professional caregivers.
abstract: OBJECTIVE
  Previous studies regarding patients' end of life (EOL) preparation have focused mainly on practical tasks, such as advance directives. In this study, we investigate the relational and personal aspects of EOL preparation, using a patient-completed questionnaire, and examine associations with clinician-patient communication (CPC) and other variables.
  
  
  METHODS
  Patients with advanced cancer but with good performance status were recruited from 24 medical oncology clinics, to participate in a cluster-randomised controlled trial of early palliative care intervention. Measures included the Quality of Life at the End of Life preparation for EOL subscale, and measures of CPC, functional status, comorbidity, spiritual well-being and symptom severity. Using chi-squared tests, t-tests and multivariate regression analyses, we examined the variables associated with preparation for EOL. We also examined the frequency distributions of individual EOL preparation items and used logistic regression to examine their associations with adequacy of CPC.
  
  
  RESULTS
  In the 469 patients, characteristics associated with better EOL preparation were better CPC, older age, living alone, less symptom burden and better spiritual well-being. Thirty-one per cent agreed that they worried 'quite a bit' or 'completely' about their family's preparation to cope with the future, and 27% agreed that they would be a burden to their family. All preparation items except regrets about life were associated with adequacy of communication.
  
  
  CONCLUSIONS
  A substantial minority of patients with advanced cancer but with good performance status are concerned about EOL preparation, particularly in relation to their families. Better CPC may help patients prepare not only practically but also personally and socially in relation to the dying process and the welfare of their families.
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Wentlandt
authors.forename: Debika
authors.initials: D
authors.lastname: Burman
authors.forename: Nadia
authors.initials: N
authors.lastname: Swami
authors.forename: Sarah
authors.initials: S
authors.lastname: Hales
authors.forename: Anne
authors.initials: A
authors.lastname: Rydall
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
authors.forename: Christopher
authors.initials: C
authors.lastname: Lo
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000473:pathology / Q000523:psychology*; D010817:Physician-Patient Relations; D011788:Quality of Life; D012111:Residence Characteristics; D012737:Sex Factors; D029181:Spirituality; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*